OCTOBER 4, 2012

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

Medicare Revises Hospitals' Readmissions Penalties
The Centers for Medicare & Medicaid Services (CMS) discovered errors in its August calculations for Medicare's Hospital Readmission Reduction Program averaging 0.02%. As a result, 1,422 hospitals with comparatively high readmission rates will lose slightly more money than they were expecting, according to a Kaiser Health News analysis of the revised penalties, while only fifty-five hospitals will have their penalties reduced. Two hospitals that were not slated to be penalized now find they will be penalized. The CMS notice can be found here. (Kaiser Health News, October 2, 2012)

Post-discharge Complications Common after Surgery, Study Finds
One in seven orthopedic, gastrointestinal, vascular or gynecological surgeries was followed by a complication within 30 days of the operation. These findings were presented at the annual meeting of the American College of Surgeons and are the result of research involving 60,000 surgical procedures performed between 2005 and 2009 in 112 VA hospitals. (ModernHealthcare.com, October 2, 2012)

JFS Awarded Obamacare Contract to Reduce Hospital Readmissions
Jewish Family Service of Los Angeles (JFS) is heading up the Mid-City Integrated Care Collaborative which has been awarded a $3.6 million three year grant to reduce readmissions, one of 18 such awards. The partnership of JFS, St. Vincent Medical Center, Good Samaritan Hospital and Olympia Medical Center will collaborate with 14 skilled nursing facilities and rehabilitation centers and numerous other organizations serving older adults in the area. Andrew B. Leeka, President and CEO of Good Samaritan Hospital, said, "We know that providing medical care for our patients does not end at our front door. The L.A. Mid-City Collaborative will bring additional resources to Medicare patients with chronic conditions, to help them receive the care they need." (JewishJournal.com, September 5, 2012)

Reducing Readmissions: It's Harder than It Looks
Jonathan H. Buroughs, MD offers his inventory of changes necessary to reduce hospital readmissions:

  1. Transition physician reimbursement from fee for service to capitation with incentives for value
  2. Create significant financial incentives for management to invest in a disease management infrastructure
  3. Implement rigorous disease management for high-risk populations
  4. Horizontally integrate case and risk management beyond the hospital's walls
  5. Utilize evidence-based pathways both in and out of the hospital
  6. Horizontally integrate the electronic health record (EHR) and the patient's personal healthcare record (PHR) so that all parties have immediate access to clinical information
  7. Create patient registers with an interdisciplinary team approach to care in and out of the hospital
  8. Focus on home health services and telemonitoring
  9. Create strong financial incentives for patients to do the "right thing" (secondary prevention)
  10. Implement public health initiatives to educate everyone regarding preventive practices (primary prevention)
Part two of this article can be found here. (Hospital Impact, September 12 and 29, 2012)

Hospital Readmission Rates Dropping Slightly, New Study Finds
A new report by the Medicare Payment Advisory Commission (MedPAC) finds that hospital readmission rates have dropped more than previously reported. The previous estimate by CMS was 0.2%, whereas MedPAC's most recent analysis puts the decrease at 0.7%, or a decrease from 13.0% of admissions to 12.3%. The difference seems to be related to the accounting of patients admitted for clinical reasons unrelated to the first admission.

Jeffrey Stensland, a MedPAC analyst, told the commission last week, "It appears from what we hear in the field that hospitals are increasing their efforts to reduce readmissions as we move closer to the start of the readmission penalty. Therefore, it appears that the penalty is serving its purpose of motivating hospitals to take action." (Kaiser Health News, September 14, 2012)

Why Hospitals Can't Settle for "Later:" Tracking Data in Real Time to Reduce Readmissions
The need for immediate feedback information to improve healthcare quality and to reduce costs and readmissions is driving hospitals or adopt new technologies. Actionable data needs to be presented before an error or a readmission occurs. "Capture those patients before they fall through the cracks and [efforts become] reactionary. Now you can do something for patients before they become statistics as opposed to only changing [something] for future patients," says Chris Cashwell, senior director of analytics-based solution marketing for health IT company Nuance Healthcare. In addition to looking at individual patients' data, hospitals can use real-time data tracking systems to analyze data for specific patient populations, not just individual patients, and identify patterns that might, for example, reduce falls. Working with the data will facilitate predicting which patients are most at risk and implementing strategies to minimize that risk. (Becker's Clinical Quality & Infection Control, September 19, 2012)

"Genius Grant" for Geriatrician Who Helped Cut Hospital Readmissions
Eric Coleman, MD, of the University of Colorado School of Medicine, is one of 23 individuals to receive the John D. and Catherine T. MacArthur Award, nicknamed the "genius grant," for developing the Care Transitions Program, a program aimed at reducing readmissions by up to 50%. It is hoped that the Program will also influence national health policy in ways that will encourage continuity of care. The Transitions of Care web site is worth visiting at http://www.caretransitions.org/caregiver_resources.asp. (AARP Blog, October 2, 2012)

Implementation Guide for Readmissions

This Guide was prepared as part of the Department of Health and Human Service's Partnership for Patients (PfP) which is intended to reduce harm in healthcare facilities. It is one of ten such guides the Military Health System has prepared.

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The National Readmissions Landscape

Amy E. Boutwell, MD, MPP
Collaborative Healthcare Strategies, STARR initiative, Faculty, Havard Medical School, Lexington, MA
Presentation Slides in PDF