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

2,200 Hospitals Face Medicare Pay Penalty for Readmissions
The Centers for Medicare & Medicaid Services (CMS) estimates that more than 2,200 hospitals will have their base Medicare reimbursements reduced. Kaiser Health News analyzed the data CMS released, and their analysis can be found here: http://www.kaiserhealthnews.org/Stories/2012/August/13/readmissions-sources-and-methodology.aspx. This site also includes several helpful links related to readmissions and data sources for the calculations. (amednews.com, August 27, 2012)

General Surgeons Identify Postoperative Complications Posing Strongest Readmission Risk
A new study reported in the September issue of the Journal of the American College of Surgeons (see http://www.journalacs.org/article/S1072-7515(12)00413-9/abstract) finds postoperative complication to be the most significant independent risk factor leading to 30-day readmissions of general surgical patients. "Complex gastrointestinal procedures carry a higher risk of hospital readmission. Pancreatectomy, colectomy, and liver resection have a higher complication rate because of the surgical complexity," said senior study author John F. Sweeney, MD, FACS, chief, division of general and gastrointestinal surgery at Emory University School of Medicine, Atlanta and director of the department of surgery's clinical quality and patient safety program. (EurekAlert, August 28, 2012)

AHCA to Apply PointRight® OnPoint-30(TM) Rehospitalization Metric
The American Health Care Association (AHCA) announced that it will incorporate PointRight's OnPoint-30 methodology of calculating case-mix adjusted hospitalization metric into AHCA's Quality Initiative. ACHA, the largest association of long term and post-acute providers, believes the move will provide an important tool for building benchmarks to identify both areas needing improvement and those in which providers excel. AHCA launched the Quality Initiative earlier this year and will help members define and reach goals in four key areas, including reducing hospital 30-day readmissions during a skilled nursing facility stay by 15% by 2015. (MarketWatch, August 30, 2012)

Ivabradine May Reduce HF Readmissions
A report on the SHIFT Trial in the European Heart Journal found that Ivabradine (Procoralan) added to standard heart failure (HF) therapy reduced HF readmissions by a third in patients with systolic heart failure compared with patients on standard treatment. "In the trial, which randomized 6,505 patients, ivabradine treatment was also associated with fewer total hospitalizations -- 902 versus 1,211 -- which was highly significant, (incidence rate ratio 0.75, 95% CI 0.65 to 0.87 P=0.0002)," wrote Jeffery S. Borer, MD, of the State University of New York Downstate Medical Center in Brooklyn. During two years of follow-up, patients had lower rates for both second and third hospitalizations for worsening heart failure. The SHIFT site can be found at http://www.shift-study.com/about-ivabradine/#. (Medpage Today, August 29, 2012)

Nurse-led Clinics Battle Readmissions
This article utilizes examples to make the point that significant progress can be made in avoiding readmissions through the simplest of interventions (e.g., avoiding dumb mistakes) and that logical and attentive nurses are in the best position to apply these simple interventions if given the authority to do so. (HealthLeaders Media, August 28, 2012)

Hospitals Took to EHRs to Reduce Readmissions
The CSC Global Institute for Emerging Healthcare Practices recently released Preventing Hospital Readmissions: The First Test Case for Continuity of Care, a report evaluating research on readmissions that examines successful approaches to reducing readmissions. Findings include the conclusions that the most effective method to reduce readmissions is to develop and use electronic health records and other technologies that are designed to follow patients more intensely once discharged. The report also recommends gathering more information on the patient's condition and social circumstances (e.g., medication reconciliation, clinic follow-up schedules, milestone tracking, etc.) while the patient is in the hospital. (InformationWeek Healthcare, August 15, 2012)

MTM Cuts Hospital Readmissions
Medication Therapy Management (MTM) is an important tool in the effort to reduce readmissions. MTM includes analytical, consultative, education and monitoring services in addition to offering other tools that can decrease readmissions. Many diseases, including those targeted in the Hospital Readmission Reduction Program, rely on medications which are a key part of the therapy after discharge. Adherence to medication regimens is important to preventing readmissions and the MTM should be central to the plan for compliance. (Drug Topics, August 10, 2012)

Estimated Size of Readmissions Penalties

The Hospital Readmissions Reduction Program established by the Affordable Care Act requires penalties be imposed on hospitals with excessive readmission results. Of the 3,367 hospitals subject to this program an estimated 2,211 will be penalized an average of 0.3%. The maximum penalty is 1.0% in FFY 2013 increasing to 2.0% in FFY 2014 and 3% in FFY 2015. To review the report by CMS go to http://www.ofr.gov/ofrupload/ofrdata/2012-19079_pi.pdf.

Source: amednews.com

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Medicaid 2014 -- Managing Expansion in Partnership with the States

Cindy Mann
Director, CHIP Services, Centers for Medicare and Medicaid, Baltimore, MD