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Lawmakers Seek 'PAC' Reform

Cheryl Clark, for HealthLeaders Media, August 30, 2013

"Let's face it," he adds. "We all know there [are] readmissions from post-acute care settings to the hospitals, some good and some that aren't good. But the hospitals are the only ones being penalized right now, and that's not the way you want to have it work.

"Our goal is to try to get everybody to perform at a higher level, and put accountability where it deserves to be."

If a home health agency has a higher number of readmissions back to the hospital than another home health agency with similar patients, or its patients seem more prone to fall or develop pressure ulcers, it could be argued that first HHA should pay a price. But what is fair?

Take a skilled nursing facility. While there is no penalty if that facility's patients are more likely to be readmitted, and that facility loses revenue from that patient for as long as they're in the hospital, today there are other incentives, such as the three-day rule, that may work in the opposite direction.

A patient who is determined to require hospital admission for three days is eligible for Medicare coverage of her post-acute skilled nursing facility stay, taking a heavy financial as well as a domestic load off of family members who aren't equipped to absorb that burden.

In its letter to the Congressional leaders, the American Hospital Association wrote "We believe that a mix of public quality reporting and pay-for-performance can align the healthcare delivery system—including post-acute providers—toward continuous quality improvement, and reward providers that improve," wrote AHA executive vice president Rick Pollack.

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