Planning (strategic, business plans)

Readmissions may be more than inpatient stays

"The use of hospital readmissions as a lone metric for post-discharge health care quality may be incomplete without considering the role of the ED." Do you agree? I would probably say yes, providing patients we include in the numerator return to the ED with an issue related to their index trip—be it clinical or ancillary.  We may not like to hear those words, but a return visit, regardless of admission, likely connotes a transition failure. Earlier in the year, JAMA examined HCUP data from three states (CA, FL, and NE) to determine the degree to which ED visits and hospital readmissions contribute to overall use of acute care services within 30 days of discharge from acute care hospitals.  The graph below illustrates the percent of patients returning to the hospital after discharge: (more…)

“The problem that won’t go away”

  Up for a 25% fee hit? We approach January 1, and again the SGR cut looms heavy.  However, now congress seeks to avert another patch with a long-term fix.  Perhaps you have heard, but an actual bill might be in the works. While the final proposal has not seen daylight—a merged house and senate product needs tuning—the fee for service payment model we have grown comfortable with will undergo a rebirth. To earn greater or equal revenue, we will need to achieve prespecified process of care and health outcome targets (VBP or value-based payment) on top of the old reimbursement chassis.  Additionally, participating in alternate payment models (APM's), e.g., patient-centered medical homes, will garner increased rewards.  A caveat, APM's work for ambulists, but not for hospitalists—and SHM has responded to CMS with proposals.  The same goes for VBP mismatches.  Stay tuned. (more…)

Observation units and who $aves

This week, JAMA IM released a nice study profiling patients on observation status for the years 2010-11.  While only involving one site, the large sample and thorough accounting of data enhances our knowledge of the growing obs trend. (more…)

Readmissions on PBS Newshour

  A nice long form feature on the Medicare Readmissions Program on the NewsHour this evening:                                         Click here to watch the video, and here to read an excellent extended PBS interview with Jordan Rau from Kaiser Health News.  The PACT program at Beth Israel Deaconess gets a nod. The money quote: "Sometimes people are like cars.  At 200K miles, nothing you do will keep them out of the shop."