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Newsletters

November 8, 2012

Reducing Hospital Readmissions

With the recent implementation of the Hospital Readmissions Reduction Program, hospital payments are being adjusted based on 3 years of claims data (July 2008 - June 2011), which showed excess readmissions after acute myocardial infarction, heart failure, and pneumonia hospitalizations.

Currently, 2,217 hospitals have been fined penalties ranging from 0.01%-1% of FY 2013 Medicare revenue and these will increase to 2% in FY 2014 and 3% in FY 2015.  While some readmissions are unavoidable, care coordination could have a substantial impact on making a successful transition from the hospital to home or skilled nursing facility.  Care coordination is vital for the Medicare population with multiple acute and chronic conditions, but in fee-for-service Medicare there is a lack of coordination of care among a multitude of providers and settings.  Many Medicare patients have a number of health events each year and this population may be physically frail or have cognitive challenges that hamper communication with multiple providers about their condition.

The June 2012 Medicare Payment Advisory Commission (MedPAC) report on Medicare and the Health Delivery System described a variety of models to improve care coordination that have been developed to maximize the experience for people who can most benefit from improving the delivery of coordinated care. The models vary in design and attempt to coordinate care by:

  • Transforming primary care practices that can better manage patients with a heavy chronic disease burden (chronic care model or medical home)
  • Utilizing a care manager role, either inside or outside the physician's office (nurse case managers embedded in physician practices)
  • Managing transitions between settings, targeting hospital patients who are discharged to other settings (transition coaches, advanced practice nurses, community health teams, or disease management organizations)

Quality Improvement Efforts & Resources

QualityNet, a CMS-approved resource, provides healthcare quality improvement news, resources, and data reporting tools and applications to hospitals, quality improvement organizations (QIOs), nursing homes, physician offices, and data vendors, and has identified a series of initiatives to reduce readmissions:

Other CMS-approved initiatives include:

For more information, check out Reducing Readmissions on Executive Insight.

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