Policy and Management Approaches to Quality

Hospital Readmissions

Here was the problem: High (1 in 5) readmission rates for Medicare patients admitted to hospitals with heart attacks, heart failure, and pneumonia. The primary concern was cost to the Medicare program.

There have been several health policy attempts to remedy the situation. Remember Medicare is a federal program and so this is federal policy.

If you have never visited the CMS web site Hospital Compare you should do so now.  Hospital Compare gives transparency to the performance of hospitals.  Hospital readmission rates are a quality measure to capture a patient outcome.  There are two intended effects.  Consumers may be able to make more informed decisions and thereby receive a higher quality of care.  Also hospitals will be able to see their relative performance and this could incentivize efforts to decrease readmission rates.

What Is Hospital Compare?

Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find hospitals and compare the quality of their care.

The information on Hospital Compare:

Remember, in an emergency, you should go to the nearest hospital. When you can plan ahead, discuss the information you find here with your health care provider to decide which hospital will best meet your health care needs.

Learn more in the Guide to Choosing a Hospital.

Hospital Compare was created through the efforts of the Centers for Medicare & Medicaid Services (CMS), in collaboration with organizations representing consumers, hospitals, doctors, employers, accrediting organizations, and other Federal agencies.

For more information on Hospital Compare, check out the CMS web cast at http://www.youtube.com/watch?v=-IeW0Zjyhrs

In fall of 2012 CMS began to financially penalize hospitals for higher than expected readmission rates for Medicare patients with these three conditions. 

This is a result of the ACA, and part of value-based purchasing as we discussed in Week 3. The goals are to create a financial incentive for hospitals to give better care; to not send home patients who are not ready to leave, to do a better job transitioning patients home to PCP follow-up. It is too soon to know if there are unintended consequences.  It is very possible that this could discourage hospitals from caring for high-risk patients.  Remember the social determinants of health. Hospitals caring for disproportionate shares of disadvantaged patients may be unfairly penalized.

ACOs may reduce readmission rates.  If an ACO has primary care and hospital components, that group is at financial risk when patients are readmitted.  It costs more to care for a patient in the hospital than in the community. This story will continue to evolve, stay tuned.

Management Approached to Quality: Readmissions

Health policy has created incentives for hospitals to reduce readmission rates.  What are the management initiatives to reduce readmissions? 

The video below is from the New England Healthcare Institute (NEHI). NEHI is a non-profit organization for health policy research. Watch this and learn about the scope of the problem and some possible solutions.

Bend the Curve: Preventing Hospital Readmissions 

Source: www.youtube.com/watch?v=dRUvsv5V1Pg&feature=youtu.be

For more information about health care quality, visit the Agency for Health Care Research and Quality (AHRQ) and check out their state dashboard. You can compare state health care quality performance indicators on specified measures. http://statesnapshots.ahrq.gov/snaps09/dashboard.jsp?menuId=4&state=&level=0




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