Countdown to higher penalties

Is July 2013 too early to think about 2014? Not if you care about reimbursement.

Given the heat that blanketed parts of the U.S. this past month, October and its cool breezes should be a month to welcome. But hospitals that have failed to avoid penalties for preventable 30-day acute MI, heart failure and pneumonia readmissions, or just squeaked by this year, may cringe at the thought. Under Medicare’s Hospital Readmissions Reduction Program, the 1 percent withholding of Medicare reimbursement for higher-than-expected readmissions will jump to 2 percent in the new fiscal year.

Elizabeth H. Bradley, PhD, of the Yale School of Public Health in New Haven, Conn., and her team have continued to try to identify strategies that help reduce readmission rates. In a study published recently, they shared results from a national survey of hospitals on heart failure practices. Six strategies were associated with lower readmission rates and four, surprisingly, with higher rates.

Some successful strategies involved partnerships and good communication with other physicians and systems involved in the patient’s care. Strategies on the other list, such as giving patients and their caregivers a written emergency plan at discharge, may have greased the wheels for early readmission by lowering barriers, they speculated.    

Looking to 2014, Marta L. McCrum, MD, of Harvard School of Public Health in Boston, and colleagues addressed an upcoming Centers for Medicare & Medicaid Services initiative that will integrate hospital mortality rates into a hospital inpatient value-based purchasing program. They wanted to explore whether 30-day mortality rates for acute MI, heart failure and pneumonia, which are used to track hospital performance, truly reflect broader hospital quality.

They concluded that hospitals with low 30-day mortality rates for the three conditions were more likely to be top performers for overall mortality. Rates for acute MI, heart failure and pneumonia also proved to be better predictors of performance than hospital size and status as a major teaching hospital.

Are these results compelling enough for a hospital to integrate them into practice? Individually each of the six successful strategies in Bradley et al’s study made a small dent in 30-day readmission rates for heart failure but in aggregate they might drop rates by two percentage points. As Bradley said, that could translate into penalties avoided and “a significant clinical change.”

What lessons has your facility learned in the first year of the Hospital Readmissions Reduction Program? Are you ready for year two? Please let us know what works for you.

Candace Stuart

Cardiovascular Business, editor