Medicare readmissions reduction program

When asked about for its views on the study's results, CMS emailed the following written statement:. CMS "is committed to ensuring that quality and safety are high priorities for patients and people with Medicare. We closely monitor performance and outcomes for all of our quality measures. This includes collaborating with stakeholders on performance criteria and carefully using the feedback to assess measure changes and impacts in our decision-making.

Follow-up research is needed to understand the effect of the misapplied penalties and then how to fix the problem, Shen said. To narrow the associated margin of error and minimize the likelihood of misclassifying performance, CMS could extend data collection from three years to 12 years for acute myocardial infarction and to six years for heart failure and pneumonia.

A possible solution could involve switching from the day readmission measure to the excess days in acute care EDAC measure to capture the full spectrum of hospital encounters — including emergency department use — within 30 days of discharge, according to another new study in the Annals of Internal Medicine , which Shen also co-authored.

The HRRP has undergone several changes since penalties first were assessed in , including an effort to account for socioeconomic differences among hospitals with larger shares of low-income patients. For instance, a January study in Health Affairs found the HRRP either had no effect on readmissions or led to an industrywide reduction in readmissions that was roughly half as large as prior estimates suggested.

The use of readmission measures also drew significant focus when a study of the high-profile Camden Coalition of Healthcare Providers, which focused on coordinating outpatient care and social services for patients with complex medical and social needs after hospital discharge, found it did not significantly reduce readmission rates.

At least one study even found an increase in mortality since HRRP penalties took effect, but one analysis by the Medicare Payment Advisory Commission found no such link. Increasing health expenditures and the pressures of the recent pandemic have contributed to the development of a new type of center of excellence COE , called the future-state COE, which is designed to better address the needs of large employers.

This COE model incorporates value-based contracting and a strong incentive design into a service-line strategy to create employee health programs that benefit employers, patients and providers alike. All models controlled for the patient and hospital characteristics.

Results: There have been statistically significant reductions in readmission rates overall as well as for vulnerable populations, especially for acute myocardial infarction patients in hospitals serving the largest percentage of low-income patients and high-risk patients. There is also evidence of spillover effects for non-targeted conditions among Medicare patients compared to privately insured patients.

Cons Potential to Disproportionately Penalize Hospitals Serving Indigent Populations Despite the above-mentioned successes, there has been considerable discussion regarding the methodology for calculating excess readmissions.

Potential to Avoid Necessary Readmissions and Increase Mortality Much attention has been given to the relationship reported between readmission and mortality measures. Concerns with Root Cause Attribution Institutions and providers cite that many readmissions are due to disease progression and patient behaviors. Arbitrary Time Window Decisions about how long past discharge to count a new admission as a readmission have also been criticized.

Potential to Overlook the Impact of Hospitalization With most efforts focused on reducing readmissions, there is a potential to overlook the stress and vulnerability patients experience. Footnotes Conflict of Interest Disclosures: None. References 1. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, Patterns of hospital performance in acute myocardial infarction and heart failure day mortality and readmission.

Circ Cardiovasc Qual Outcomes. Zhang W, Watanabe-Galloway S. Ten-year secular trends for congestive heart failure hospitalizations: an analysis of regional differences in the United States.

Congest Heart Fail. Medicare Payment Advisory Commission. Report to the Congress: promoting greater efficiency in Medicare. Report to the Congress: reforming the delivery system.

Department of Health and Human Services. Centers for Medicare and Medicaid Services. Acute inpatient PPS. Readmissions reduction program. Report to the Congress: Medicare and the health care delivery system. Affordable Care Act update: implementing Medicare cost savings. Hospital-wide all-cause unplanned readmission HWR measure. Hospital day heart failure readmission measure: methodology. Hospital Day acute myocardial infarction readmission measure: methodology. Hospital Day pneumonia readmission measure: methodology.

Hospital Engagement Network. Fiscal year hospital readmissions reduction program: measure methodology report. Kaiser Health News. Armed with bigger fines, Medicare to punish 2, hospitals for excess readmissions. Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program. FY final rule data files.

Risk prediction models for hospital readmission: a systematic review. Hospital strategies associated with day readmission rates for patients with heart failure. Community-based care transitions program. Frequently asked questions about billing Medicare for transitional care management services.

Bloink J, Adler KG. Transitional care management services: new codes, new requirements. Fam Pract Manag. Fact sheets: proposed policy and payment changes to the Medicare physician fee schedule for calendar year New York Times. Medicare to start paying doctors who coordinate care for patients. Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke, New HHS data shows major strides made in patient safety, leading to improved care and savings.

American College of Cardiology. Hospital to Home. American Heart Association. Institute for Healthcare Improvement. Interventions to Reduce Acute Care Transfers. Preventing day hospital readmissions: a systematic review and meta-analysis of randomized trials. Evaluating quality of care for patients with heart failure. National patterns of use and effectiveness of angiotensin-converting enzyme inhibitors in older patients with heart failure and left ventricular systolic dysfunction.

The Joint Comission. Improving America's hospitals: The Joint Commission's annual report on quality and safety Association between performance measures and clinical outcomes for patients hospitalized with heart failure. Investigators O-H and Hospitals. Diagnoses and timing of day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia.

Do countries or hospitals with longer hospital stays for acute heart failure have lower readmission rates? Circ Heart Fail.

Burwell SM. Setting value-based payment goals--HHS efforts to improve U. The readmission reduction program of Kaiser Permanente Southern California-knowledge transfer and performance improvement. Perm J. Rodin D, Silow-Carroll S. Medicaid payment and delivery reform in Colorado: ACOs at the regional level. The Commonwealth Fund. Federal Register. Revisions to payment policies under the physician fee schedule. Income inequality and 30 day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort study.

Socioeconomic status and readmissions: evidence from an urban teaching hospital. Health Aff Milwood ; 33 — National Quality Forum. Review of draft national quality forum NQF report: risk adjustment for socioeconomic status or other sociodemographic factors. Utility of socioeconomic status in predicting day outcomes after heart failure hospitalization. Are all readmissions bad readmissions? Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia.

The relationship between hospital admission rates and rehospitalizations. Proportion of hospital readmissions deemed avoidable: a systematic review. Incidence of potentially avoidable urgent readmissions and their relation to all-cause urgent readmissions. Thirty-day readmissions: the clock is ticking.

Thirty-day readmissions--truth and consequences. Medicare hospital quality chartbook: performance report on outcomes measures. Sharp rise in Medicare enrollees being held in hospitals for observation raises concerns about causes and consequences.