Health Affairs / RWJF brief explores improving care transitions

Posted on September 26, 2012 | No Comments

PDF Version
Details
Library
Implementation Briefs

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.

No Comments

Public comments are closed.

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.
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.
The Congressional Budget Office presents the long-term budget outlook under two scenarios in a new report. These scenarios embody different assumptions regarding future policies governing federal revenues and spending. The first, the extended baseline scenario, reflects the assumption that current laws generally remain unchanged and that lawmakers will allow changes that are schedule under current law to occur, forgoing adjustments routinely made in the past that have boosted deficits. The second, the extended alternative fiscal scenario, incorporates the assumptions that certain policies that have been in place for a number of years will continue and some provisions of law that might be difficult to sustain for a long period will be modified. These two scenarios span a wide range of possible policy choices. The report focuses on the next 25 years and gives special focus to outlays for major health care programs. Under both scenarios, the report estimates that total outlays for federal health care programs will grow much faster than the gross domestic product (GDP), increasing from 5.4 percent of the GDP in 2012 to nearly 10 percent in 2037. National health care spending is also expected to rise. Health care expenditures is expected to increase to almost one-quarter of the GDP by 2037. CBO suggested that key factors contributing to this growth in spending have been the emergence of new medical technologies, rising personal income, and the expanding scope of health insurance coverage.
An analysis recently released by The Commonwealth Fund uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country. However this high spending cannot be attributed to higher income, an older population, or greater supply or utilization of hospitals and doctors. Instead, the findings suggest the higher spending is more likely due to higher prices and perhaps more readily accessible technology and greater obesity. Health care quality in the U.S. varies and is not notably superior to the far less expensive systems in the other study countries. Of the countries studied, Japan has the lowest health spending, which it achieves primarily through aggressive price regulation.
UC Berkeley, funded by grants from the Robert Wood Johnson Foundation and The California Endowment, recently released the brief, "The Promise of the Affordable Care Act, the Practical Realities of Implementation: Maintaining Health Coverage During Life Transitions," which discusses seamless health coverage under the Affordable Care Act for individuals and families who lose health insurance because of a work or life transition. While outreach and education are essential for enrollment, such efforts are not sufficient to assure that those eligible will enroll in programs during these transition periods. This policy paper addresses the question, "How can implementation of the Affordable Care Act build on institutional connections and develop widespread cultural knowledge of the availability of coverage during life transitions that precipitate the loss of private coverage?"
In their recent publication, "Building Tomorrow's Healthcare System: The Pathway to High Quality, Affordable Care," BlueCross BlueShield Assocation (BCBSA) calls for incentives to reward safety and reinforce primary care. One of the nation's largest insurance companies, BCBSA encourages federal government to adopt "value-based purchasing" and urges individuals eligible for Medicare or Medicaid to enroll in managed care plans. The Association also wants faster implementation of these types of programs in order to show savings more quickly.
In an article published in Health Affairs, actuaries with the Center for Medicare and Medicaid Services project US health spending will grow at a rate .2 percent faster under health reform than projected under prior law (6.3 percent instead of 6.1) over the next decade. They also estimate the administrative costs for health reform will be $2.4 billion for the US Department of Health and Human Services, $37.7 billion in state and federal costs for establishing insurance exchanges, and an increase of $31 billion in state and federal administrative costs for Medicaid.
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.