AUGUST 16, 2012

Welcome to the Medicare Readmissions Update eNewsletter
Editor: Philip L. Ronning
This issue sponsored by the Readmissions Web Summit

Final IPPS Rule Has Three New Value-Based Purchasing Measures, Finalizes Readmissions Factors
CMS has issued its final rule for hospital inpatient prospective payment and in doing so included three new outcome measures: 1) a central line blood stream infection measure, 2) a patient safety indicator measure and 3) a Medicare spending per beneficiary measure. This rule also finalizes the payment adjustment methodology for heart attack, heart failure and pneumonia readmissions which CMS estimates will save them approximately $280 million. (Inside Health Policy, August 1, 2012)

Ready for a Reality Check on Hospital Readmissions?
As of October 1, 2012 hospitals' readmissions ratio will begin to affect their inpatient payments according to the Affordable Care Act's Readmissions Reduction Program. These measures are based upon results in acute myocardial infarction (AMI), heart failure and pneumonia. This focus on readmissions is based in part on a 2007 MedPAC (Medicare Payment Advisory Committee) study that found 76% of readmissions were potentially preventable. (3M Health Information Blog, July 12, 2012)

Managing Preventable Events
In its July/August issue Healthcare Executive published an article detailing strategies for reducing potentially preventable events (PPEs). Sandeep Wadhwa, MD, CMO, 3M Health Information Systems, the article's author, suggests five strategies for managing PPEs: 1) encourage clinical leadership, 2) analyze data, 3) distinguish between quality and coding issues, 4) provide information to the medical staff, and 5) engage physician service line leaders in data review. Ronald L. Kaufman, MD, FACHE CMO Tenet California/Nebraska Region says, "Clinically specific data allows teams at hospitals to better focus their internal reviews and develop performance initiatives in a systematic way that reflects the real challenges facing each hospital." (Healthcare Executive, July/August 2012)

Sources and Methodology: Where the Hospital Readmissions Data Came From
On August 1, 2012 CMS published data tables containing individual hospital's Readmissions Adjust Factor, a multiplier CMS will use beginning October 2012 (CMS Fiscal Year 2013) to reduce payments to all Inpatient Perspective Payment System (IPPS) hospitals. The multiplier is penalty of 0.0% up to 1.0% of base DRG reimbursements. This article provides the analysis of KHN staff of the methodologies used as well as several links to key sources surrounding the Hospital Readmissions Reduction Program. (Kaiser Health News, August 13, 2012)

New Health Practice Leading to Better Patient Care?
AdvocateCare, an ACO established by Advocate Healthcare in January of this year, is reporting lower readmission rates. Advocate Healthcare is a Chicago-based system of 10 acute care hospitals and more than 250 sites. AdvocateCare now provides services to 380,000 Blue Cross Blue Shield of Illinois enrollees and is one of the nation's oldest and largest ACOs. (Chicago Sun Times, August 3, 2012)

Home Health Alliance Says Analysis Underscores Cost-Savings Potential
The Clinically Appropriate and Cost-Effective Placement (CACEP) project, a series of reports by the Alliance for Home Health Quality and Innovation (AHHIQI), shows in its most recent offering that the use of home care prevents avoidable hospitalizations and readmissions for pre-acute, post-acute and non-post acute episodes. In suggesting that savings could be significant, the report summary says, "If home health providers can treat patients longer and provide chronic disease management services, there may be an opportunity to keep non-post-acute care patients from even entering the hospital." (Inside Health Policy, August 8, 2012)

Assisted Living Program for Reducing Rehospitalizations Could Have National Impact
Brookdale Senior Living and the University of North Texas have received a $7.3 million HHS Health Care Innovation award for an initiative to reduce hospital readmissions from assisted living facilities. Dr. Kevin O'Neil, Medical Director at Brookdale, believes half of all readmissions from skilled nursing facilities are preventable. "When someone moves from one venue of care to another, especially for older adults who may have multiple medical issues, it often results in things falling through the cracks," O'Neil says. The INTERACT (Interventions to Reduce Acute Care Transfers) program is described in this article. (Senior Housing News, August 13, 2012)

5-Point Strategy to Reduce Readmissions
This article suggests a five-point strategy to reduce readmissions. The recommendations are these: 1) think globally about technology, 2) conduct due diligence beyond the four walls of a hospital, 3) forget about "one throat to choke," 4) deploy technology that drives utilization, and 5) keep cultivating relationships with community-based patients. (Healthcare Finance News, August 7, 2012)

Hospitals Treating the Poor Hardest Hit by Readmissions Penalties

It has been recognized for some time that poorer patients are most likely to be readmitted due to lack of access to physicians, difficulty securing medications, trouble getting to the physician's office for follow- up care, etc. "You're probably going to end up penalizing those very places that need to put resources into patients when they leave the hospital," said Atul Grover, chief public policy officer of the Association of American Medical Colleges. Yet CMS notes that some hospitals serving the poorest populations, such as Denver Health, are able to keep readmissions in check, demonstrating that reducing readmissions is possible even among disadvantaged populations. (Kaiser Health News, August 13, 2012)

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Medicare Policy Issues for the Future

Robert Berenson, MD
Institute Fellow at the Urban Institute, Washington, DC