RWJF Event: Transitioning Away from Readmissions

The Robert Wood Johnson Foundation will convene a national conversation on Feb. 13th to highlight successful ways to improve care transitions and reduce avoidable hospital readmissions. The event is part of Care About Your Care, a national initiative to share promising ideas with patients and health care providers.

Nancy Snyderman, MD, chief medical editor for NBC News, will lead national experts and audience members in a discussion about bringing together patients, care providers, and community services to ensure better health care outcomes.

This live event, which will also be streamed online (at the website linked above), will feature:

· Risa Lavizzo-Mourey, MD - RWJF president & CEO
· Eric Coleman, MD - University of Colorado Anschutz Medical Campus
· Mary Naylor, PhD, RN - University of Pennsylvania School of Nursing
· Jonathan Blum, MA - Centers for Medicare and Medicaid Services

Representatives from care teams from across the nation who are working on innovative ways to improve care transitions

WHEN: Wednesday, Feb. 13, 2013 from 12:30–2:00 p.m. ET

CMS Announces Hospital Readmission Rate Penalties

More than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show.

Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide.

With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system. Hospitals have had little financial incentive to ensure patients get the care they need once they leave, and in fact they benefit financially when patients don’t recover and return for more treatment.

The penalties, authorized by the 2010 health care law, are part of a multipronged effort by Medicare to use its financial muscle to force improvements in hospital quality. The penalties will fall heaviest on hospitals in New Jersey, New York, the District of Columbia, Arkansas, Kentucky, Mississippi, Illinois and Massachusetts, a Kaiser Health News analysis of the records shows. Hospitals that treat the most low-income patients will be hit particularly hard.

A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey, North Shore University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a teaching hospital of Harvard Medical School.

Healthcare systems Criticize NQF Over Support of Readmissions Measure

A recent Modern Healthcare article (free registration required) states that a group of eight large hospitals and health systems are taking the National Quality Forum (NQF) to task, decrying not only the organization's endorsement of a measure targeting hospital readmissions, but also calling into question the NQF's entire consensus-reaching process.

In a two-page appeal letter sent to NQF on May 24, the hospitals and health systems raised serious concerns about the potential impacts of a hospital-wide all-cause readmissions measure, which was endorsed by NQF on April 24 and discussed in a June 11 conference call. They state that without adequate risk adjustment and room for exclusions, the readmissions measure could “create confusion, limit hospitals' ability to identify improvement and prompt others to unfairly judge the performance of hospitals.

Providers also worry that the measure, which they see as unreliable, will likely be used by the CMS to gauge hospital performance and determine Medicare payment. The CMS' Readmissions Reductions Program, mandated by the healthcare reform law and set to begin in fiscal year 2013, will reduce Medicare payments for hospitals with the highest rates of readmissions. Many are speculating about how the recently endorsed readmissions measure will fit into that program.

The measure, developed by the CMS and researchers at Yale University, New Haven, Conn., estimates a single risk-adjusted 30-day readmission rate for each hospital, covering all conditions and procedures related to general medicine, neurology, cardiovascular care, cardiorespiratory care, surgery and gynecology.

Providers' unease about linking preventable readmissions and quality is not surprising, said Dr. Ashish Jha, associate professor of health policy and management at the Harvard School of Public Health, Boston. Jha co-authored an April article in the Journal of the American Medical Association in which he called policymakers' focus on 30-day readmissions misguided. He argues that not all readmissions are preventable, particularly when so many determining factors are out of hospitals' control. Jha said hospitals may be investing their limited time, energy and resources on strategies to prevent readmissions, at the expense of other quality-improvement priorities.

Alliance of Community Health Plans Report on Readmissions

As hospitals wrestle with ways to bring down readmission rates, a new Alliance of Community Health Plans report looks at five key steps that improve patients’ odds of being able to go home and stay there. Though the program is still in the early stages, some data suggest that ACHP members with care transition programs are bringing down readmission rates and reducing costs. Still, only a few AHCP plans found “concrete” cost savings from their programs so far.

 

The report discusses five practices that plans identified as key facilitators of their programs’ success, helping to break down silos of care, promote coordination among providers and engage patients to facilitate effective transitions from hospital to home:

• Using data to tailor care transition programs to patients’ needs
• Anticipating patients’ needs and involving them early in the transition process
• Engaging providers to become program partners
• Leveraging technology to improve care transitions
• Incorporating care transitions into broader quality initiatives

NTOCC Launches Transitions of Care Evaluation Tool for Health Care Quality Improvement

The National Transitions of Care Coalition (NTOCC), an organization dedicated to improving patient transitions through the healthcare system, has launched a new tool to facilitate the advancement of care quality. The Transitions of Care Evaluation Software, a web-based program provided at no cost to the user, is designed to meet the needs of organizations ready for an advanced stage of transitions of care improvement efforts.

Available through a secure Internet website accessible from NTOCC's homepage, the software is a convenient, online option for institutions looking to document and evaluate transitions initiatives. User features include data entry, data analysis and report generation, allowing for data visualization over time. In addition, multiple evaluation projects may be managed under a single organization's umbrella.

The Transitions of Care Evaluation Software is available at http://www.ntocc.org/, where interested parties may learn more and preview the platform, register for an account and begin using the Software.

Webinar: Can Health Plans Improve the Quality of Transitions From Hospital to Home?

The Alliance of Community Health Plans (ACHP) and Avalere Health are hosting a webinar to discuss their new report, Transitions of Care from Hospital to Home, which examines how health plan initiatives break down care silos to improve care through direct engagement with patients and care coordination between providers. Participants will examine five practices identified by ACHP member plans as key to successfully implementing programs to improve patient transitions from hospital to home.

When:  Tuesday, April 24, 12–1 pm ET

The expert panel will include:

• Dan Mendelson, CEO and Founder, Avalere Health
• Patricia Smith, President and CEO, Alliance of Community Health Plans
• Kim Horn, President and CEO, Priority Health
• Patrick Courneya, MD, Medical Director, HealthPartners

Why: 

•  Hospital readmissions are high - nearly one in five Medicare patients discharged from a hospital is readmitted within 30 days, leading to high costs of care, poor quality and low patient satisfaction, according to research published in the New England Journal of Medicine1.
• Health plans can play a vital role in coordinating patients’ care transitions, especially as a centralized source of patient information that increasingly spans across a variety of settings.
• Avalere’s new report for ACHP found that health plans credit their care transition initiatives for positively improving health outcomes, costs of care, and patient satisfaction.

Register:  To register for this webinar and view log-in information, click here and follow the instructions on the screen.

New Dartmouth Atlas report on hospital readmissions and post-acute care

As part of this month’s Care About Your Care initiative, the Dartmouth Atlas Project and the Robert Wood Johnson Foundation are also jointly releasing a companion report with tips for patients leaving the hospital to help them and their caregivers improve care coordination.

An embargoed copy of Care About Your Care: Tips for Patients When They Leave the Hospital can be downloaded here: http://www.dartmouthatlas.org/downloads/reports/Atlas_CAYC_092811_embargoed.pdf

Also, After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries looks at care by region and by academic medical centers, and an embargoed copy can be downloaded at the link below: http://www.dartmouthatlas.org/downloads/reports/Post_discharge_events_092811_embargoed.pdf

HeartLink Program Reduces Hospital Readmissions

“The patient doesn’t pay, the hospital takes on that financial responsibility,” Kardis said. “But if you manage a patient – it costs much less to follow a patient than to have them in the hospital for a day.”

Under some of the new care models encouraged by health reform, such as a medical home, accountable care organization, or bundled payment system, the financial incentives would line up differently, potentially making programs like this one even more cost-effective. Read the full post...