Responding to value-based-purchasing, provider groups across the US are implementing or tweaking programs to reduce unnecessary hospital readmission or emergency department visits. Much of this is stimulated by Medicare’s plans to move the bulk of their payment into new models and the current incentives around readmission reduction for beneficiaries with certain conditions. Continue reading
Ever wonder how states (or CMS) set thresholds for readmission rates? Much has been said about and written on the subject, but there a few things I think are highly overlooked.
1. Organizations actually set readmission rates themselves
Now before you fire off an email to me, let me clarify. Documentation (or lack thereof) on a patient’s health status is gathered by government agencies via claims data and analyzed. In determining readmission rates, what else is at their disposal on a detailed claim besides diagnoses and health status? As a whole, lack of complete documentation for many years gave data to CMS and state agencies that may not have told the whole story on the health of a populations. And remember, CMS and states are typically utilizing a three-year rolling period of data. So not only did our documentation probably not accurately reflect the health of our populations three or even five years ago, we probably aren’t doing it correctly now either. Continue reading
When thinking of quality outcomes improvement, much focus is on the particular quality concern (such as a readmission, accidental laceration, etc.) and reducing the incidence through better practice, improved documentation or coding. But not enough attention is focused on risk-adjustment for the various quality indicators. And sadly, this is the easiest part to fix! Continue reading
As many of us in health care realize, sometimes it is just not possible to keep patients out of the hospital! All of our best strategies are in some cases not used, or in others, did not work. So how do we keep patients out of the hospital? Per chance we are putting the cart before the horse. Let me explain. Continue reading
Introduction by Norbert Goldfield, MD, and Richard Fuller
Increasing value, or more precisely, improving outcomes from health care spending, a recurring theme of the C&ER blog, is intrinsically linked with risk-adjustment. If we can’t accurately compare patients, then we can’t determine if we are paying too much for their care. We cannot be certain if their health outcomes deviate from what we should expect. As governmental and private payers increasingly employ both managed care and prospective payment programs with more complex patient populations, the need for accurate risk-adjustment grows exponentially since cost variation across patients is greater. This variation is often greatest in pediatric populations, which range from healthy kids to some of the sickest individuals insured by government programs. Continue reading
American health care continues to rank as the least cost-effective system in the developed world. Why? You might be tempted to say that, until recently, there was no incentive to change. A purely economic view is that the costs to healthcare providers have been greater than the payoff.
The economic landscape is changing. Quality reporting, value-based purchasing, Meaningful Use, risk-based contracts, and other reforms have created rewards and penalties intended to improve the value of health care. Will they work? Well. . . Ask instead, “How could they fail?” Continue reading
You’ve got your quality data. Now what?
Hospitals don’t lack for data on quality outcomes. The real question is what to do with it. Even after making sure the data is sound—by checking documentation, coding for accuracy, and verifying the integrity of data in the EHR, for example—people often wonder how to understand and use the information.
There aren’t easy answers. But, there are good answers and many, many good examples. A number of 3M customers are improving patient outcomes through deliberate and innovative uses of their quality data. Continue reading
In January the Minnesota RARE campaign received the prestigious Eisenberg Award for reducing avoidable readmissions. Over an 18-month period, the campaign helped hospitals and community partners prevent more than six thousand hospital readmissions.
Although each hospital faces its own unique challenges in managing readmissions, the RARE campaign demonstrates what a supportive and collaborative effort can achieve. It involves 82 hospitals, 100 community partners, and 3 operating partners, including the Minnesota Hospital Association. Continue reading
An alien watching a 500 meter relay would think the race is all about the baton. Why else would these beings dedicate themselves to getting this object to its destination as quickly and flawlessly as possible? A relay race would not exist without the baton to bind the individuals together and create a team event. Although each team member’s leg of the race is important, the requirement that the baton be handed from one team member to the next turns four separate runs into a single, unified performance that can be evaluated and rewarded for its overall excellence.
In the relay that is the U.S. healthcare system, the patient is the baton—and the patient baton is not as fortunate as the white plastic one. In the current healthcare set-up, the hospital discharges its responsibility for the patient’s care once it discharges the patient. Then the patient is passed like a baton from one set of provider hands to the next, wobbles and all. Continue reading
When talking with practitioners at the sharp end of health care there is concern about the unintended results of policies that create penalties or rewards to encourage change. Take, for example, the familiar Hospital Readmissions Reduction Program, a major cost containment initiative for CMS. There is argument over the structure of the penalties, the lack of a positive financial reward, accuracy of the risk-adjustment, what constitutes a readmission – but there is little argument that it has grabbed the attention of the hospital community and has elicited a response over and above terse denunciation of the policy.
In some ways the structure of the payment incentive works. It makes a single entity accountable; the penalty is sizeable enough to warrant action, but not too big to cause instant extinction for a failing provider. Continue reading