Reducing Unnecessary Hospital Readmissions

Despite my self-imposed pledge to not publish partisan political posts, I am unable to contain my enthusiasm for one of the of  President Obama's Affordable Care Act: the creation of the Center for Medicare and Medicaid Innovation.  The Center seeks to:

help transform Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) through improvements in the health care system, thereby ensuring better health care, better health, and reduced costs for beneficiaries, and ultimately enhancing the health care system for all Americans.

Innovate to improve care! Gosh. Why didn't anyone think of that before? The Center is a profound experiment in improving how the Federal government works to improve our lives and I  recommend following the Innovation Center on Twitter (@CMSInnovates) or subscribing to its e-mail newsletter, to anyone who desires greater understanding on how Medicare (and Medicaid) are proactively pursuing new ideas in health care delivery.

Community-based Transitions Program

A terrific example of the Innovation Center's initiatives to improve health care delivery is the Community-based Care Transitions Program (CCTP), which seeks to reduce the number of Medicare patients who are readmitted to a hospital within 30 days of discharge. Nearly one in five Medicare patients -- approximately 2.6 million seniors -- are readmitted to hospital within 30 days at a cost of over $26 billion every year! The government considers unnecessary readmissions to be symptomatic of our nation's uncoordinated and inefficient health care deliveyr system. CCTP launched in 2011 with the goal of funding community-based organizations (CBOs) will use care transition services to manage Medicare patients' transitions and improve their quality of care, with the goal of reducing readmissions by 20%. Nationwide, 47 providers are currently participating in CCTP and the participating Illinois CBOs are: CJE SeniorLife, AgeOptions and Catholic Charities of the Archdiocese of Chicago. Up to $500 million in total funding is available foe 2011 through 20015 and the CBOs will be paid an all-inclusive rate to manage the Medicare patient's post-hospital discharge to prevent readmission.

The Initiative:

Recognizing that the problem of readmissions also involves Medicare patients who reside in skilled nursing facilities, last week the Innovation Center announced a new Initiative to avoid hospitalizations among nursing facility residents. Many nursing home residents are Medicare-Medicaid enrollees and research shows that approximately 45% of hospital admissions among those receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided, accounting for 314,000 potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures in 2005.

The seven independent (non-nursing facility providers) selected for the Initiative will partner with CMS to employ evidence-based interventions to reduce hospital admissions among nursing home residents. For example Indiana University will implement an intervention in 20 nursing facilities in the Indianapolis region of Indiana. The intervention will include the deployment of RNs and advanced practice nurses (APNs) to be on-site at the nursing facilities, allowing for enhanced recognition and management of acute change in medical conditions. RNs and APNs will coordinate with nursing facility staff and residents’ primary care providers and will employ other evidence-based protocols (validated in other care settings) to reduce hospitalizations.

Conclusion:

On October 1, the new penalty phase for the Hospital Readmission Reduction Program went into effect: penalizing those hospitals which have too many unnecessary readmissions within 30-days after discharge. Approximately 2,000 hospitals will forfeit about $280 million in Medicare funds over the next few years unless they successfully reduce readmissions.

By incentivizing improvements in care delivery in three care settings (hospitals, the community and nursing homes) the Innovation Center's initiatives will hopefully reduce medical costs while improving the health and well-being of older adults. For now, we'll have to wait and see what the data will show. What do you think? Learn more on Twitter @aginginchicago.

 

 

 

 

Comments

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  • It's Hospitals serving the poor hit hardest.... http://medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2012/09/24/why-are-hospitals-having-trouble-reducing-readmission-rates-

    Many hospitals, especially those serving low-income communities, find their patient base frequently lacks the means or education to follow the measures in a discharge plan. Patients don’t fill prescriptions or keep appointments with primary-care physicians, if they even have one. Or perhaps they don’t have transportation to the doctor’s office. Or their health literacy is low to begin with. There just isn’t the support structure in the community for the patient to stay well.

    Prestigious hospitals such as Barnes-Jewish in St. Louis have been embarrassed by media exposés of poor readmission rates, and have had to institute expensive remedial plans to help low-income patients.

    The problem for the health system as a whole is the variability among institutions, Romano said. “To penalize the safety net hospitals for taking care of the most vulnerable patients is worrisome,” he said. “It is precisely these hospitals that need more resources.”

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    Bruce Lederman

    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a multi-facility skilled nursing facility company.

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