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CHF Readmission Prevention Efforts Costly for Hospital

Cheryl Clark, for HealthLeaders Media, July 27, 2011

He added that if there isn't payment policy reform "in a way that pays for this, and incentivizes hospitals to do this kind of work, you're not going to get everybody doing it, or, you will have places doing it that can't afford it long term and that's not a good way to run a system."

Stauffer said that the study's findings were a surprise, and the first time to his knowledge that anyone has looked at readmission efforts at this level, with a smaller community hospital. He emphasized that from a societal perspective, preventing readmissions means keeping patients healthier in the long run, and that saves many other kinds of costs for physicians, procedures, home care or skilled nursing care.

In the report, Stauffer and colleagues emphasized that estimated reductions in reimbursements for heart failure readmissions by the Centers for Medicare & Medicaid Services that will take effect during the next three years reduces the negative impact, but "by only 10%. A bundled payment system, based on a 30-day post-discharge episode of care in which no additional payments would be made for readmission, makes them financially more attractive than usual care.

"However, the modified reimbursement system would result in a significant reduction in contribution margin if payment rates are set at the current level for HF (heart failure) index admissions under Medicare's prospective payment policy, without additional consideration for the cost of interventions such as TCPs (transitional care programs)."

Prior research illustrates the enormity of the problem. In 2004 alone, Medicare paid $17.4 billion for unplanned rehospitalizations, which one in five hospitalized beneficiaries go through within 30 days of discharge. But for patients with congestive heart failure, the rate soars to 50% who must come back to the hospital within 30 days.

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1 comments on "CHF Readmission Prevention Efforts Costly for Hospital"


gcgeraci (7/28/2011 at 1:11 PM)
Was any analysis done to see if there were any cost differences between providers- and any providers that provided care below the Medicare DRG payment (with equal or better quality?) There are often wide profiles for similar diagnoses in terms of cost of care, and if a best practice can be identified or created that keeps the costs lower at equal or better quality, that may be a more effective strategy for the hospital in the short run.