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CSC report examines how to reduce hospital readmissions

Posted on August 9, 2012 | No Comments

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Implementation Briefs

According to a white paper released by CSC, a significant portion of hospital readmissions can be prevented through comprehensive discharge planning and patient support. The report, entitled “Preventing Hospital Readmissions: The First Test Case for Continuity of Care” notes that preventing readmissions can prove challenging, as many of the precipitating causes for readmission are outside of the direct control of the hospital. However, the brief concludes that appropriate discharge planning paired with adequate post-discharge patient care and support can reduce readmissions for high-risk hospitals. The challenge, according to the paper, will be to coordinate, as opposed to duplicate, care and support.

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In a report released yesterday, the Center for American Progress (CAP) introduced the Senior Protection Plan, a proposal to reduce federal spending on health care delivery. Instead of shifting costs and/or ultimately increasing costs, the Senior Protection Plan, according to CAP, would improve health care delivery efficiency, eliminate waste, and improve the quality of care. This approach, in theory, would ultimately reduce health care spending. The Senior Protection Plan serves as an alternate to the other proposals made in the past years with the goal of reducing health care spending. Such proposals include transforming Medicare into a premium support or voucher program, raising Medicare's eligibility age to 67, increasing cost-sharing, and slashing Medicaid and increasing long-term care costs for seniors. The Senior Protection Plan would enhance competition based on price and quality, increase transparency of price and quality information, reform health care delivery to provide better care at lower cost, repeal the Sustainable Growth Rate (SGR) mechanism, reform graduate medical education and the workforce, reform Medicare premiums and cost-sharing, reduce drug costs, bring Medicare payments into line with actual costs, cut administrative costs and improper payments, reduce the costs of defensive medicine, reform the tax treatment of health insurance, and promote better health. CAP's Senior Protection Plan yields substantial savings, as scored by the Congressional Budget Office, without harming beneficiaries. The plan would save over $385 billion in federal expenditures over 10 years. In addition, the tax policies related to health care would generate up to $100 billion over 10 years. The plan also includes an array of reforms that would bend the cost curve over the long term. For the report summary, click here.
Last week, the New England Journal of Medicine (NEJM) released a study entitled, "Effect of Nonpayment for Preventable Infections in U.S. Hospitals." The NEJM study examines the impact of Affordable Care Act (ACA) provisions to reduce Medicare and Medicaid reimbursement rates for hospitals that report certain preventable infections. The findings of the study indicate that the Centers for Medicare & Medicaid Services' (CMS's) policy of withholding funds from hospitals that report such infections does not help to lower these infection rates. In the discussion of their work, the study authors recommend that policymakers consider replacing the current system with a model that will encourage behavior that will lower rates of infection.
Health Affairs and the Robert Wood Johnson Foundation published a new policy brief regarding efforts to improve care transitions. Care transitions are movements that patients make among health care providers and settings as their needs change during the course of illness. Without well-planned coordination, these transitions may result in patient harm and needless expense. According to the brief, researchers estimated that in 2011, poor transitions caused between $25 and $45 billion in wasteful medical spending through avoidable complications and unnecessary hospital readmissions. Topics covered in the brief include the causes of poor care transitions, improving care transitions, and policy options to address transition coordination.
In a new analysis by the Medicare Payment Advisory Commission (MedPAC), hospital readmissions for Medicare beneficiaries dipped .7% between 2009 and 2011. This is good news for hospitals which will face readmissions penalties beginning October 1. Starting on October 1, Medicare will lower reimbursement rates for thsoe hospitals that fail to reduce hospital readmission rates related to pneumonia, heart failure, and heart attack. The government's overarching goal is to reduce readmissions by 20%, which would save the federal government more than $2.5 million per year.
In a Commonwealth Fund-supported report recently published in the New England Journal of Medicine, researchers found that U.S. regions where discharged hospital patients are readmitted at comparatively high rates are often the same regions where overall hospitalization rates are high. This relationship indicates broad, systemic problems within the U.S. health care system. The study, conducted by Arnold Epstein, M.D., Ashish Jha, M.D., and John Orav, Ph.D., examined rehospitalization rates across the country for Medicare patients with congestive heart failure and pneumonia, while also looking at how other variables, such as overall hospitalization rates, differences in patients' coexisting conditions, quality of discharge planning, and the number of hospital beds and physicians, affected readmissions. Of all the potential causes for regional differences in readmission rates, overall hospital admission rates played the biggest role, accounting for 16 percent to 24 percent of the variation in cases of congestive heart failure and 11 percent to 20 percent for pneumonia cases. No other factor accounted for more than 6 percent of the variation.
Hospitals in the United States readmit an average of 20% of Medicare patients within thirty days of their initial discharge. These readmissions cost the Medicare program an estimated 12 billion dollars each year and may be an indicator of poor quality of care where the readmission was potentially preventable. In its June 2007 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) classified many hospital readmissions as potentially preventable. Based on these recommendations, Congress included the Hospital Readmissions Reduction Program (HRRP or Program) in the Affordable Care Act. CMS issued the final rule implementing the HRRP on August 18, 2011, although CMS will continue to clarify additional details of the program through future rulemaking.
Provides funding for a temporary high-risk health insurance pool for individuals with pre-existing conditions.