Biting the All-Cause Readmissions Bullet
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"I would say that many of our readmission reduction programs are disease agnostic," says Zeev Neuwirth, MD, chief medical officer and senior vice president of ambulatory care and corporate services for Charlotte, N.C.–based Carolinas HealthCare System, a 38-hospital network with 7,460 beds in North and South Carolina.
Neuwirth says that through collaborations with skilled nursing facilities, "we're in the process of putting together quality metrics with our nursing homes that we are sending our patients to—a dashboard—and beginning to be transparent, to see who's doing well and who can improve."
These hospitals are biting the all-cause bullet in part because they recognize federal rules expand by four the number of conditions in the penalty algorithm by Oct. 1, 2014, "and to other conditions and procedures as determined appropriate by the Secretary," according to Section 3025 of the Patient Protection and Affordable Care Act. A final rule expected soon may help clarify how far the Centers for Medicare & Medicaid Services will want hospitals to go.
Those four, identified by the Medicare Payment Advisory Commission, are: chronic obstructive pulmonary disease, coronary stent procedures, vascular surgery, and coronary bypass procedures.
In April 2012, the National Quality Forum endorsed two all-cause readmission measures, one of which was "codeveloped" by CMS and researchers at Yale University, and leaders presume it will soon be featured in a proposed payment rule, and a sure sign that is weighing on the agency's thinking. The algorithm includes a risk-standardized rate of unplanned readmissions among adult patients hospitalized for surgery, gynecology, general medicine, cardiorespiratory, cardiovascular, or neurological conditions or procedures.
The second measure, designed for health plan quality monitoring, counts any adult inpatient stay followed by an acute readmission for any diagnosis within 30 days, contrasted with a calculation of the probability of an acute readmission.
"In an effort to reduce inappropriate readmissions, our hospitalists and ambulatory physicians are meeting together to create solutions that provide more seamless coordination of care during the transition from hospital to home," Neuwirth says. "We are piloting numerous innovative initiatives involving technology, which include using iPads to communicate with patients at home and evaluate the safety and healthfulness of homes, and home biometric monitors to track patients on a daily basis."
A project that launched in 2010 enabled the Carolinas' Blue Ridge HealthCare network of Morganton, N.C., a group of 75 physicians and 17 extenders, to work on readmission rates for heart failure, pneumonia, heart attack, and also COPD. While readmissions declined significantly for the three conditions covered by the current Medicare penalty, so did readmissions for patients with COPD, which went from 12.56% in 2011 to 11.59% in 2012.
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