$500M in Readmission Prevention Funds to Bypass Hospitals

Keeping hospitals out of the revenue loop was intentional. Section 3026 was specifically designed to avoid the conflict of interest that occurs when a hospital, which receives its funding by providing acute care, is asked to launch efforts to prevent the need for that care, threatening revenue.

Brock, of the Colorado QIO, has some perspective on the hospital/CBO conflict.

"This is what's revolutionary about Section 3026, and this is why some in the medical service sector are uncomfortable with it," Brock says.

"It's an acknowledgement that much of what drives people back to the hospital is not medical. It's really embedded in the social milieu that they live their lives in: Do they have transportation? Do they have someone to call when they have questions? Do they feel comfortable in their home? Are their neighbors their friends?  Or do they not trust their neighbors?"

Brock has great hopes for the success of Section 3026, but she also understands the hospitals' reticence.

When Section 3026 passed, she recalls, a lot of hospitals thought it would give them money to standardize discharge processes, get electronic information to primary care providers. "I think many were hopeful this would...restructure a bucket of money for them." Instead, they were left out of the money flow.

"I imagine that upon first consideration, some hospitals might feel, 'Oh My Gosh, we are entrusting patients to this fly-by-night little CBO,'" she said.

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