Saturday, August 18, 2012

Can't get them to (re-)admit a mistake

Some time ago, I pointed out a report that indicated underlying problems with the use of readmissions data as the basis for financial penalties for hospitals. I also pointed out research that demonstrated potential unintended consequences from this kind of regulatory action.  Well, once the boulder of government regulation gets moving, there is little to be done to stop it.  Here is a thoughtful and reasonable comment by the Massachusetts Hospital Association:

The federal government’s Centers for Medicare and Medicaid Services (CMS) last week announced reimbursement penalties for more than 2,000 hospitals — including a number in Massachusetts – because of the facilities’ 30-day readmission rates.  “No hospital community is doing more to address readmissions than Massachusetts,” said MHA President & CEO Lynn Nicholas. “Our hospitals are committed to providing safe, high-quality patient care, and are national leaders in voluntary, public reporting of patient quality and safety information. MHA supports the concept of working collaboratively with others to improve the readmission rate and recognizes that financial incentives can play a constructive role. But it must be recognized that hospitals do not control most of the factors that affect readmissions. Hospitals can perform their roles with all due diligence and yet may not see a significant impact on the readmission rate. So programs that are designed to address the readmission rates should take that reality into consideration.”
MHA believes that CMS has failed to comply with the requirements of the ACA to not count readmissions that are for conditions unrelated to the initial hospital admission, or for readmissions that are part of a scheduled medically appropriate care regimen such as chemotherapy.
Hospitals across the state are currently participating in numerous projects to address and reduce hospital readmissions, in particular the STate Action on Avoidable Readmissions (STAAR) initiative. Participating hospitals have formed cross-continuum teams and submitted baseline 30-day readmission rates, and are now busy determining how to improve the patient's transition from hospital to post-acute settings. In addition, in 2010 the MHA Board of Trustees unanimously endorsed an association-wide initiative to move beyond public reporting and transparency to make measurable, concrete improvements in hospitals' performance, with a particular focus on readmissions.

1 comment:

Keith M, MD said...

I'm glad to see that the MHA, like most other health care organizations, is working diligently to reduce readmissions. It's only recently that most systems have recognized that a large proportion of readmissions reflect flaws in the coordination and communication processes that surround hospitalization. And why is it that these organizations care about readmissions? Because CMS focused their attention! No doubt that hospitals do not control all aspects that affect the readmission process, but that does not free them of the responsibility for addressing the problem. As the recipients of the largest share of federal health care dollars it stands to reason that they would be identified as targets for both fines (in this case) and benefits (in the case of the HITECH act).
As a long term member (40+ years) of the health care community, I take my hat off to CMS for finally addressing quality issues that should have been worked on long ago.
Claims of "it's not my responsibility" work only for so long in resisting needed changes.