Readmissions

It’s That Time again…

It’s that time of year again, when hospitals around the country are being notified of their 30-day readmission penalties from CMS. Now in the fourth year of the program, many hospitals have come to dread the announcement of how much they are being penalized each year.1 This year the readmission reduction program will decrease Medicare payments within a total of 2,592 U.S. hospitals, for a combined total of $420 million.2 Unfortunately, safety-net hospitals were about 60% more likely than other hospitals to have been penalized in all 3 years of the program. In addition, hospitals with the lowest profit margins were 36% more likely to be penalized than those with higher margins. Despite criticisms of the program, there is no doubt that it has forced hospitals to pay keen attention to transitions of care and avoidable readmissions. And it does appear to be an effective strategy for CMS to achieve…

Misjudge the Outlier Patient at Your Peril

  A few weeks ago, I wrote about small numbers of patients consuming large and disproportionate shares of health care goods.  The thinking being, if we focus efforts on outliers, hospitals will save money and FTEs by economizing in the right places.  Why waste resources on interventions applied to fifty percent of the hospital population when only ten or twenty will do. While dogma still holds, i.e., a few folks will always consume the greatest slice of the health care pie, we tend to view the statistic at a population-based and not individual level. A recent release from Health Affairs should force us to reconsider our assumptions: For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary  The study investigators probed to determine whether a cohort of high-needs people who received the label "outlier" remained static over time.  A first of its kind…

Hospital readmissions and length of stay

  I am pleased to cross-post a terrific piece from The Incidental Economist on the sometimes rival effects of LOS shortening and readmissions.  (I can't recommend TIE enough by the way--and do not let the title fool you, it is a health care site). We feel the yin and yang tensions daily on this subject: discharge promptly ("sicker and quicker") but own the transitions process to avoid return trips.  We may be justified in having those tensions, however, as you will see below.  The literature base continues to expand on this topic, and you will find the overview with its links a helpful resource in generating discussions within your groups. Read!!   The following is a post by Jennifer Gilbert, a Clinical Research Coordinator at Massachusetts General Hospital. She provides background research for The Incidental Economist, and previously researched at Harvard School of Public Health in the Department of Health Policy…

Hospitalists Rise, Medicare Falls

Sorta. A new study out today in JAMA you will want to know about: How has Medicare done on the inpatient side from 1999-2013? Medicare all-cause mortality?  DOWN (more…)

Super-Utilizers: Will they be buying or renting beds?

Costs in health care tend to concentrate in the domains of the few (think 80/20 rule).  As it goes for chronically ill community dwellers, the same applies to frequent flyers in the ER.  You may have heard of the term super-utilizers. Those individuals present week after week with innumerable complaints, sometimes pedestrian, sometimes critical--always finding themselves back on the ward for weeks at a time.  As expected, they have weak community support and comorbidities in need of TLC, often requiring services not available in their neighborhoods (mental health and substance abuse counseling come to mind). The local house of worship, community center, or corner bar have limits, and they only offer so much spiritual renewal or sustenance.  We all struggle to find a balance for these folks.  We see them a lot.  And thus, the ER becomes their second home. (more…)
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