The CMS is pushing hospitals to establish more aggressive care plans and to team up with non-medical personnel such as social workers in a new guidance aimed at reducing readmissions for minority and low income Medicare enrollees.
Minority and other vulnerable people with chronic conditions such as congestive heart failure are more likely to be readmitted within 30 days of discharge than their white counterparts, according to the CMS.
“Given the cost and quality implications of these findings, addressing readmissions while caring for an increasingly diverse population has become a significant concern for hospitals and hospital leaders,” the CMS wrote in the guidance (PDF).
The document was developed in collaboration with the Disparities Solutions Center at Massachusetts General Hospital and the National Opinion Research Center (NORC) at the University of Chicago. It is part of the CMS' Equity Plan for Improving Quality in Medicare (PDF).
Instead of changing how it assesses hospital readmission data, the CMS wants hospitals to address the problem with measures described in the guidance released Tuesday.
The steps include developing a “radar” or awareness of the individuals who are commonly readmitted. If, for example, certain racial/ethnic groups are more likely to be readmitted, then cultural specific training for staff and providers would increase. Hospitals should also obtain interpreter services should the individuals speak another language, the guidance said.
Hospitals should also develop case-management teams that include not only pharmacists, nutritionists, mental health providers, but “non-traditional” team members such as community health workers, navigators and health coaches.
“Investing in these resources, derived from the communities-at-risk, will be essential,” according to the guidance.
The document comes as The Medicare Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with relatively higher rates of Medicare readmissions, enters its third year. The penalties are as much as 3% of Medicare payments.
There had been a push from industry stakeholders to include adjustments for socio-economic status when the agency reviews readmission data, but the CMS has pushed back, fearing softening penalties for hospitals with lower-income patients would hold those hospitals to a lower standard and unintentionally weaken incentives for those hospitals to improve health outcomes for disadvantaged patients.
For fiscal 2016, only 799 out of more than 3,400 hospitals subject to the HRRP performed well enough on the CMS' 30-day readmission program to face no penalty. Thirty-eight hospitals will be subject to the maximum 3% reduction, according to CMS data.