Leaders Propose Ways to Lower Hospital Readmissions

Approximately 20 percent of Medicare beneficiaries discharged from a hospital were rehospitalized within 20 days, according to a recent article in the New England Journal of Medicine.

The authors of the study, “Rehospitalizations Among Patients in the Medicare Fee-For-Service Program,” published April 2, estimate rehospitalizations accounted for about $17.4 billion of the $102.6 billion in Medicare hospital payments in 2004.

In a White House blog, posted April 8, Office of Management and Budget Director Peter R. Orszag said two of the proposals the Obama administration put forward as part of their health care reserve fund involves better incentives for reducing hospital readmissions.

Orszag says in the blog, “Under the Administration’s proposal, hospitals with high rates of readmission will be paid less if certain patients are re-admitted to the hospital within 30 days, beginning in 2012. Our proposal would also bundle payments to hospitals to cover not just hospitalization, but also care from certain post-acute providers for the 30 days after hospitalization. This combination of incentives and penalties should lead to better care after a hospital stay and result in fewer readmissions—saving roughly $26 billion over ten years.”

The Centers for Medicare & Medicaid Services (CMS) responded quickly to the New England Journal of Medicine article as well with some news of their own. Fourteen sites have been selected for participation in the Care Transitions Project—a new pilot prgram CMS is conducting through summer 2011.

The 14 communities selected to participate in the project are: Providence, R.I.; Upper Capitol Region, N.Y.; Western Pennsylvania; Southwestern New Jersey; Metro Atlanta East, Ga.; Miami, Fla.; Tuscaloosa, Ala.; Evansville, Ind.; Greater Lansing Area, Mich.; Omaha, Neb.; Baton Rouge, La.; North West Denver, Colo.; Harlingen, Texas; and Whatcom County, Wash.

Each community will be led by a state Quality Improvement Organization (QIO) to help health care providers, consumers, and others meet the goal of the Care Transition project, which is “to equip hospitals with the tools necessary to avoid re-hospitalizations today, so that potential financial consequences could be avoided tomorrow,” a CMS representative said.


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15 Responses to “Leaders Propose Ways to Lower Hospital Readmissions”

  1. Wilda Reddock says:

    I would like to know how those communities were selected, what is the criteria to sit and or participate in tthe transition care project.
    I am a Registered Nurse.

  2. Wilda Reddock says:

    I do hope to hear from you I would be delighted to know more about this project.

    I have two Schools of thought 1. to provide the type of care to promote optimum health is grand some thing I was looking forward too, and have always participated.

    Hospital Census will be much less over a period of time.

  3. Renee says:

    For more information about the Care Transitions Project, visit http://www.cfmc.org/caretransitions/. To learn more about the work that QIOs are doing across the country, visit http://www.cms.hhs.gov/qualityimprovementorgs.

  4. Cheryl says:

    I see one problem with this readmission proposal & that is when a patient is non-compliant with the medical direction that is supplied upon hospital discharge then why should the hospital/physician be punished for the patient’s lack of committment to his/her health. We see many bounce back patients & it is for this exact reason. I think this proposal has flaws & really needs to be reconsidered.

  5. Sheri says:

    I agree with Cheryl that patient’s do need to be compliant and that non compliance or lack of following thru with discharge instructions is a big reason for readmission.

    However, I also think that a lot of these folks are discharged too early without proper instruction or referral to community agencies that could help them stay on track and compliant.

    Many health insurance companies have discharge planners (usually LPN’s or CNA’s) that will call a patient once they are home to verify that they understand the next steps to their recovery or staying healthy. If all healthcare entities did the same thing, maybe we would have better outcomes. Results of the study will be interesting to see.

  6. Sally says:

    This is just another way for CMS to penalize caregivers. I do the coding for a group of hospitalists, and read all the notes for patients who have a stay in the hospital. Extensive discussions with patients are done through out the stay and upon discharge. I believe that many patients that are re-admitted, are suffering from many ailments and once discharged to their “homes” (because they refuse to go to a rehab of some sort), continue with their current (non-compliant) living situations.

    I also believe that many patients are discharged too soon, but because of payor guidelines, case management, and DRG reimbursements, the providers of care do what they can to instruct their patients to follow up with their primary or specialists for continuing care of their conditions.

    Maybe this study, will see what I see, but I doubt it.

  7. Mary says:

    I agree with Sally. Although I don’t know that I see it as a penalty for hospitals. Our area is rural, the hospital has it’s own Home Health agency which already seems to get the lion’s share of the reimbursable Home Health cases. Having the hospital responsible for the in-home care for 30 days post discharge can only hurt the smaller Home Health agencies more.

    I also agee that it does not appear that anyone took into consideration the patient’s freedom of choice not to follow our instructions and recommendations for improved health.

  8. CAROLYN says:

    I don’t see how penalizing the hospital’s reimbursement is going to result in fewer readmissions. True, there are patient’s that are non-compliant, but there are also those who are genetically predisposed to poor health or have an illness so debilitating that result in complications that warrant a readmission. This is not a way for CMS to penalize caregivers, the article clearly states this was a proposal of the Obama administration.

  9. Barbara says:

    I am an RN experienced in both case management and utilization review and have worked directly with discharge planners. Many patients are discharged to unfavorable conditions. Until communities successfully manage societal issues that face the aged, disabled and chronically ill the pattern of readmissions will continue. Perhaps CMS should focus on the reasons patients are readmitted and work to improve those issues? Too bad a federal agency needs become involved with problems that should be addressed by families and local communities. I wonder what the readmission rates are in countries such as Japan where families care for their ill, aged and disabled members?

  10. Susan Proctor says:

    All this so called use of incentives to provide better care is just crazy. I do not think that some issues can have market (free or otherwise) concepts applied to them in this way. We have seen time and again in the public and private payer sector what happens when paying less or otherwise using incentives is applied to the practice of medicine. It’s better to understand the complex issues of how and why various regions have better care and then apply them elsewhere. All this use of data and dollars to try and drive quality health care is flawed in so many ways. First, you have to understand what quality health care is, understand how it can be delivered (set the standards), then deliver it, look at the new outcomes, and then make improvments. We don’t even begain to do this as a nation, and this is why we need to have a natioal health care progam that can use our health care dollars for quality instead of wasting money on financial flim flam payment schemes.

  11. Sheri in Colorado says:

    Having worked for a provider group that offered a ‘Triage Nurse’ to field calls, I believe as stated above the answer lies in educating patients. Most of the triage calls received did not require further hospitalization, but could be handled over the telephone (reassurance or re-directing, verification of medications & dosages, script renewals or changes, community resources, etc). Some were brought into the office for re-checks and a few were directed to the ER.

  12. Diane Moore says:

    Having worked as a case mgt nurse in a large city hospital, I have seen many patients return with their same health issues. Compliance is a big issue. Follow up after discharge is desparately needed. Unfortunately, some patients should not return directly home from the hospital because they need nursing assistance, or 24/7 close monitoring. However, if Medicare doesn’t cover that non-skilled nursing need, few can afford to self-pay. Trying to get people to go to Rhab or skilled nsg facilities was always a struggle. And, try being an elderly person with multiple hospital discharge instructions…..total comprehension is always a concern. Medicare / Medicaid should allow a weekly Home Healthcare visit until they see their doctors for the first follow up. This grp also should never be scheduled for anything greater than a 4 wk follow up. As for national health insurance……you can’t get more “National” than Medicaid & Medicare……& this is a huge problem grp for returns.

  13. Lynn says:

    Medicare via the QIOs have been reviewing readmissions for years and denying the readmission if it was related to the previous admission. This is nothing new. What is new (and great) is having a funded project that focuseds on looking at the points of transition in care, and trying to come up with ways to strenghten them, and identify the problems and barriers. I applaud the health systems that volunteered to be part of this project. I think the non-compliance issue will be very evident and this is just the type of project needed to document and measure that particular problem, so it can be factored in and dealt with systematically.

  14. Marilyn says:

    Sounds like Mr. Obama and his regime are looking for ways to ameliorate the $1-3 trillion dollars of increased spending per year (including the deficits) by focusing our attention on hospital readmissions to save $26 billion over 10 years. The only really good part of the pilot program is perhaps readmission reasons will be more apparent and better documented. As long as people have free will, there are going to be patients who choose not to or are unable to care for themselves properly after discharge and who will have to return to the hospital. How many of the readmissions are due to early discharges because of DRG requirements, too? Unless Medicare changes some of its rules on deductibles and co-pays and DRG’s there is not an incentive to have a patient well enough to be on their own prior to discharge. On the contrary, sometimes it is more financially feasible to discharge for a short time and then readmit. I hope that the pilot program is successful in making reasons for readmissions more clear.

  15. MBB Hlthcr says:

    Agree with all points presented. Let us not forget the role of the family and their responsibilities in caring for the elderly. If all of us engage to ensure our older folks are taking the right meds, nutrition, physical exercise for mobility and provide them with a nurtured environment – that would decrease readmits considerably.

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