But I am not ambivalent about one thing: The CMS policy on readmission penalties falls clearly into the "other hand" category. The program is wrong-headed in intent, flawed in design, and will have unintended consequences.
The Premier Safety Institute puts it nicely (sorry, an email newsletter with no link):
CMS has forged ahead despite concerns raised by the Premier healthcare alliance and other hospital groups about the potential for some safety net hospitals, those treating disproportionately large numbers of low income patients, to face penalties that they can least afford. There are also concerns about a lack of consideration in the penalties for planned or unrelated readmissions. Questions also continue about the methodology for measurement and lack of adjustment for socio-economic status.
But even the respected Kaiser Health News falls for the trap in its summary:
More than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show. Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide.
It should read, "as the government begins a wide-ranging push to save money by penalizing health care providers based on a poorly conceived premise and poorly designed methodology."
Dear hospital folks, expect more of these kinds of metrics and penalties. The folks in DC are primarily looking for money. They are adopting administrative approaches to find it and have disguised their financial mechanisms with a veneer of concern for quality.