The Hospital Readmissions Reduction Program: Cautions and Caveats
Posted Apr 03 2013 12:06am
"Maybe you should go back to the hospital!"
Ask most wonks - especially ones who never took care of a patient - about "readmissions," and, after quoting this article , these health policy Urkels will tell you that returning to a hospital is the poster-child of all that ails U.S. medical care. Providers who can't get it right the first time, they say, are not only giving slipshod care, but are double dipping because their mistakes generate even more fat fees the second time around.
"Balderdash!" says the Disease Management Care Blog. Many Medicare inpatients are so sick that it's a miracle that they get to go home in the first place. Keeping patients in the hospital can be more life-threatening than the home environment and, when things don't get well after a discharge, it's often more a function of social support than medical skill.
The NEJM authors recommend three modifications to CMS' HRRP 1. Include patients' socioeconomic status in any risk adjustment modeling. One easy-to-obtain modifier, for example, could be whether the patient is on Supplemental Security Income . Patients on SSI are less able to cope, which is why they quality for the program in the first place.
2. Include hospitals' mortality rates in any risk adjustment modeling. Hospitals with special expertise are less likely to have borderline patients die on their inpatient services, which means they'll have their more than their fair share of fragile survivors.
Since it's unlikely that HRRP program is going away, the DMCB agrees with the three recommendations. In the meantime, it also suggests 1. CMS should be held accountable by Congress to execute well on the program,
2) Claims analytics - possibly using a " Big Data " approach - should be applied to Medicare claims to examine whether hospitals are turning to two potential options to undermine the program a) gaming the system by altering how they "code" the billing for their readmission patients, or
b) accepting the penalty because of favorable income from readmissions.