Jonathan Blum, CMS principal deputy administrator, touted that figure in testimony during a Senate Finance Committee meeting in February, calling it evidence that the healthcare reform law was moving the needle on hospital quality.
The Patient Protection and Affordable Care Act included a number of provisions aimed at curbing Medicare readmissions—seen as a marker of low-quality care—that cost about $26 billion annually.
The Community-Based Care Transitions Program, for instance, will award a total of $500 million through 2015 to community organizations to test methods of improving transitions between care settings and preventing repeat trips to the hospital.
The CMS' Hospital Readmissions Reduction Program, a pay-for-performance program that penalizes hospitals with higher-than-expected readmission rates for heart attack, heart failure and pneumonia patients, was also mandated by the reform law. More than 2,200 hospitals will see their Medicare payments docked in 2014 under the program, when the maximum penalty jumps to 2%, up from 1% this year.
Experts said the new data underscore hospitals' increasing attention to the issue. “It's remarkable,” Dr. Brian Jack, chair of Boston University's department of family medicine, who led the creation of an intervention known as ReEngineered Discharge that's used in hundreds of hospitals. He attributed the drop in readmissions at least partly to a growing understanding that keeping patients out of the hospital requires a multipronged approach involving hospitals, primary-care physicians, family caregivers and community-based groups.
Dr. Mark Williams, chief of hospital medicine at Northwestern Memorial Hospital, Chicago, questioned whether the rise in observation stays had affected the data. “We need to see the data,” said Williams, who heads Project BOOST, or Better Outcomes for Older adults through Safe Transitions, another effort targeting care transitions and readmissions.
Federal officials said the drop in readmissions could also be seen at a more granular level. In 232 of 306 local healthcare markets, average readmission rates for the first eight months of 2013 were at least half a percentage point lower than average rates for 2007 through 2011, they said in the post.
“Using the same comparison, readmission rates also went down in 49 states and the District of Columbia. The only state that did not see a decrease—Utah—already had one of the lowest readmission rates in the country,” according to the CMS.
Dr. Eric Coleman, director of the Care Transitions Program at the University of Colorado Denver, said this latest round of data shows the “trends in reduction are real.” Coleman, whose program served as the blueprint for the CMS' Community-Based Care Transitions Program, said ACA-established penalties for readmissions may have grabbed hospitals' attention. But the real improvement was driven by collaboration among quality improvement organizations, hospital associations, providers and other groups.
“Will rates continue to improve or will they flatten out?” he asked. “Was there low-hanging fruit that hospitals went for right away? The next set of data points will show us if the effect is sustainable.”
Follow Maureen McKinney on Twitter: @MHMMcKinney
