The issue, he says is new 30-day mortality measures federal payers have woven into the healthcare reform law's value-based purchasing algorithm for incentive payments starting October 1. Hospitals with higher numbers of pneumonia, heart failure, or heart attack patients who die within 30 days of discharge during the performance period (the latest one ended June 30, 2012) will fare poorly in their overall VBP score.
That's because the weight of those three measures affects 25% of 1.25% of the hospital's Medicare base DRG payments.
But written into the rule is a key exception that Kupfer says has not gone unnoticed by clinicians and the hospitals that employ them:
If patients are designated for hospice care during their first 24 hours of their hospital stay, and then die within 30 days of discharge, they aren't counted against the hospital's score.
Is Kupfer saying that physicians will be a little quicker to enter high-risk, older patients with multiple health issues into hospice, resulting in them not getting care that could benefit them and extend their lives?
"Right," he replies. "I'm concerned that hospitals will exert pressure to move patients into hospice, even if they're appropriate patients for hospice, but will do it within the first 24 hours. Even if it puts them at odds with families," who need more time to make that important and emotional decision.