Clock starts on readmissions withholdings

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 - Candace Stuart - Landscape
Candace Stuart, Editor, Cardiovascular Business

Monday marks the beginning of the great unknown: the hospital readmission reduction program. The program is a component of the Patient Protection and Affordable Care Act designed to lower Medicare costs by penalizing hospitals with higher-than-expected readmissions rates for heart failure, acute MI and pneumonia.

As of Oct. 1, unscheduled readmissions will count in the formula. One Medicare Payment Advisory Commission analysis placed the cost of preventable readmissions for these three conditions at $903 million. But how to avoid these “preventable” readmissions remains a pressing question.

Many research efforts have tackled the issue. Most recently, Kociol et al found no association between processes for reducing unplanned, short-term readmissions for heart failure and readmission rates. The results were based on a telephone survey that focused on inpatient care and education, discharge and transitional care and general quality improvement efforts.

The October issue of Cardiovascular Business explored the challenges hospitals face as they attempt to implement strategies to contain readmissions based in some cases on little evidence that the efforts work. The potential penalties add to the urgency and anxiety: Beginning in fiscal year 2013, the Centers for Medicare & Medicaid Services will withhold up to 1 percent in payment to poor performers, increasing to 2 percent in 2014 and 3 percent in 2015. In 2015, the program expands to include chronic pulmonary obstructive disease, CABG, PCI and other vascular conditions.   

In the coming months and years, we can expect to hear much more about efforts to improve patient quality, reduce 30-day readmissions and the effects of the hospital readmission reduction program on patient care and provider’s bottom line. As designed, it likely will help the federal government chip away at healthcare costs, but at what price?

We’ll keep you informed.

Candace Stuart
Cardiovascular Business, editor
cstuart@trimedmedia.com