As the federal government seeks to make hospitals more accountable for high readmission rates, the industry has a clear message for policymakers: Dont penalize hospitals for readmissions that are beyond their control.
Red flags raised
Hospitals wary of interest in readmission rates
Reducing readmission rates in hospitals to improve quality and save money has been a talked-about reform option among Washington policymakers for some time, and some expect the federal government to eventually tie readmission rates to reimbursement.
The focus on readmission rates is coming from some big players. Last year, the Medicare Payment Advisory Commission went so far as to recommend that hospitals with relatively high readmission rates get a reduction in payment as part of a larger plan to improve hospital efficiency. President Barack Obamas 2010 budget blueprint also cited reducing hospital readmission rates as an $8.4 billion cost-saver over 10 years, a measure that could be used to finance Obamas plan to establish a $634 billion health reserve fund.
And, just last week, the CMS announced that it had chosen 14 communities across the country to participate in a pilot project to eliminate unnecessary hospital readmissions.
With so much attention on readmissions, some see it as almost inevitable that federal payments will be linked to readmission rates. In order for hospitals to continue doing business with Medicare, its very likely that some sort of financial model will be established on readmissions in the future, said Margaret Namie, vice president of quality at five-hospital Mercy Health Partners, Cincinnati, which is part of Catholic Healthcare Partners. Readmission and care transitions are line items on Obamas budget, so they are going to be addressed, although no one knows what that will look like yet, said Namie who has been involved in several programs that have successfully reduced hospital readmission rates of heart-failure patients.
The hospital industry is not anticipating any new proposals on readmission payment policy soon, but the groundwork is being laid for such a change. The CMS would first need congressional authority to implement that policy change, said a hospital industry source who spoke on the condition he not be identified.
However, its possible that the agency could have a discussion and request comments on ways of addressing readmissions in the hospital inpatient prospective payment rule as they did last year, the source said. The IPPS proposed rule for fiscal 2010 is expected to be released sometime this month.
Before imposing any new payment penalties on what are viewed to be overly high readmission rates, however, the CMS and other policymakers need to keep in mind that not all readmissions are unnecessary, industry executives say. Some are good readmissions for instance, someone might be readmitted because they have regular inpatient chemotherapy treatments, said Edward Hannon, CEO of 49-bed McDowell Hospital, Marion, N.C. In addition, not all readmissions can be anticipated, he said. Someone could be readmitted 30 days later for something completely unrelated to the earlier admission, he said.
If Medicare is moving toward a payment system that will someday penalize hospitals for high readmission rates, they have to look for the right thing, and that theyre not causing patients further harm, Hannon warned. As an example, there may be consequences to patients whose care isnt going to be reimbursed for being readmitted to the hospital, he said.
But CMS officials insist that scrutiny of readmission rates is long overdue. Our data show that nearly one in five patients who leave the hospital today will be readmitted within the next month, and that more than three-quarters of these readmissions are potentially preventable, said CMS acting Administrator Charlene Frizzera in a written statement. A recent study in the New England Journal of Medicine found that unplanned rehospitalizations among Medicare beneficiaries are expensive and frequent, accounting for $17.4 billion of $102.6 billion Medicare paid to hospitals in 2004.
Theres no question that the Journals findings are grounded in fact, said Steve Landgarten, chief medical officer at eight-hospital Ardent Health Services, Nashville. The results reflect a failure of post-hospital care, he said. To the extent the hospital fails to provide appropriate care and a premature discharge occurs, I think its reasonable to hold hospitals accountable.
While its important to ensure that patients arent being kicked out of the hospital too soon, the reality is the vast majority of readmissions are not due to premature discharge. Many readmissions occur because of lack of followup care or other factors, Landgarten said.
Patients often dont have the healthcare coverage to follow up with a doctor or other healthcare provider. Or, they literally cant afford to refill a prescription. In these cases, it would be unfair to penalize the hospital, he said.
For now, it doesnt appear that the CMS pilot project will be testing a penalties/rewards system for high or low readmission rates. The agencys goal is to find real-world clinical solutions to healthcare quality problems that can be implemented without widespread CMS payment or policy change, a CMS spokesman said. Each of the pilot communities will be led by a state Quality Improvement Organization that will work with providers, consumers and stakeholder groups to implement hospital and community systemwide interventions. The precise details about each intervention will vary, based on the communitys unique needs, the spokesman said.
Even if the pilot is successful, Landgarten cautioned that reducing readmission rates on a national basis will require a huge investment in resources so that patients will be able to comply, and have access to adequate post-hospital care at whatever level they need.
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