Update on Reducing Hospital Readmissions- by Elizabeth Hogue

Wisdom from an expert in the field---Elizabeth Hogue, Esq.-noted legal expert in Home Care

Most hospitals nationwide face substantial penalties from the Medicare Program because discharged patients are readmitted within thirty days of discharge.  Hospitals subject to penalties for readmissions are actively seeking assistance to reduce or eliminate penalties that may be as high as 3% because they amount to millions of dollars in lost revenue.  Post-acute providers of all types, including home health agencies, private duty agencies, hospices and home medical equipment (HME) suppliers, and assisted living facilities (ALFs) are ideal partners for hospitals in their quest to avoid penalties for readmissions.  Now is the time for providers and discharge planners/case managers at hospitals to collaborate to reduce these rates through the use of Preferred Provider Agreements and/or Care Transitions Agreements. 

A good starting point for providers and discharge planners/case managers to negotiate such Agreements is to identify the penalties incurred by the hospitals.  Although hospitals likely already know this information, home care providers can find it on the website of the Centers for Medicare and Medicaid Services (CMS) at www.cms.gov in preparation for discussions with hospitals. 

The next step is to identify those patients discharged from hospitals who are at high risk for readmissions.  A new study entitled “Patient Characteristics and Differences in Hospital Readmission Rates” that appeared in the Journal of the American Medical Association (JAMA)  Internal Medicine by Michael L. Barnett, John Hsu and J. Michael McWilliams on September 14, 2015, seems to be helpful. 

The purpose of the study was to assess the extent to which a comprehensive set of patient characteristics may account for differences in readmission rates to hospitals.  The study included 8,067 admissions to the hospital from 2009 to 2012.  Patients were selected based on survey data from the national Health and Retirement Study (HRS) that was linked for HRS participants enrolled in the Medicare Program.

A total of twenty-nine characteristics of patients were assessed from this data as potential predictors of readmissions to hospitals within thirty days of discharge when added to standard adjustments made by the Medicare Program to hospital readmission rates.  The authors then compared the distribution of the characteristics studied between patients admitted to hospitals with relatively higher or lower readmission rates as reported by Medicare.  Finally, the authors estimated differences in the probability of readmissions between groups of patients before and after adjusting for additional characteristics.  The main outcomes and measures were readmissions for all causes within thirty days of discharge.

Based on the study, researchers concluded that several dozen variables, including the factors listed below, accounted for almost half of the difference in readmission rates between the best and worst performing hospitals:

-          Patients’ level of education

-          Patients’ income

-          Patients’ ability to bathe, dress and feed themselves

This conclusion has led some commentators to suggest that Medicare’s program to reduce readmissions may unfairly penalize hospitals that serve poor patients.  This means that collaboration between providers and hospitals is even more important at hospitals that serve population of poor patients.

The variables described above also make it clear that providers and hospitals should focus on patients’ ability to bathe, dress and feed themselves in order to avoid readmissions.  This is important information for collaboration between hospitals and providers.

Hospitals and home care providers must, of course, also bear in mind that Preferred Provider Agreements and Care Transition Agreements cannot interfere with patients’ right to freedom of choice of providers.  Arrangements between providers and hospitals to provide care transition services must also be structured to avoid the provision of free services to hospitals and patients by providers.

The industry’s efforts to “wrestle this issue to the ground” have just begun, but collaboration between hospital discharge planners/case managers and providers is clearly a key to success.

© 2015 Elizabeth E. Hogue, Esq.  All rights reserved. 

No portion of this material may be reproduced in any form without the advance written permission of the author.

ICD-10 has thrown some of our competitors clients in a tizzy

October 9, 2015: Dallas, TX

Yesterday, I received a phone call/report from a key friend/business ally in Florida who owns a Billing Company, describing how distraught many of his billing clients are due to how their claims are being rejected by CMS since the conversion of the healthcare billing and coding to the October 1st conversion from ICD-9 to ICD-10.
For those who are not involved in Healthcare, ICD-10 refers to the International Classification of Diseases diagnostics codes which specifies which code needs to be used for the patient's diagnostics.The US converted to ICD-10 on Oct. 1, 2015, after it was approved by the World Health Organization in 1992.The rest of the world has been using ICD-10 since the mid 1990's.
( yes, we in the US are laggards, but that is the theme of another day's commentary.)
My work with Axxess has been going on for over 4 years, and I am the so proud of our Engineering Team... now---more than ever.
Our clients are billing and making money, since October 1st, 2nd, 3rd,5th, 6th, 7th, and 8th, and will be able to bill and get funds today and next week. 
Moreover, we have our Axxess DDE Revenue Cycle Management tools assisting our clients, so they can see their remittance flow on a day-to-day, moment to moment basis.

The panic and crying out amongst the clients of competitors is reaching our ears. Reports are coming in form all over the US.
Behold, it is time for harvest.

Our Axxess engineering team nailed the ICD-10 conversion. This underscores this  fact: At Axxess, we are all about helping our clients make money.
These Engineers at Axxess, all located as a team here in the United States, are led by our CIO and Mobile Application Team Lead, and our Core Management Team--every player on these teams each and all are very competent. This IS industry leadership. Not talking about it. Doing it.

Come one come all! Come to Axxess where your software vendor gets it right -- the first time.

Kaiser and JAMA Infographic: Men's healthcare is behind that for women

Independence at Home Demonstration: a real Medicare cost saver!

Affordable Care Act payment model saves more than $25 million in first performance year

Date

2015-06-18

Title

Affordable Care Act payment model saves more than $25 million in first performance year

Contact

go.cms.gov/media

Affordable Care Act payment model saves more than $25 million in first performance year
Independence at Home practices succeed in improving care, lowering costs

The Centers for Medicare & Medicaid Services (CMS) today announced positive and promising results from the first performance year of the Independence at Home Demonstration, including both higher quality care and lower Medicare expenditures.    

"These results support what most Americans already want-- that chronically ill patients can be better taken care of in their own homes. This is a great common sense way for Medicare beneficiaries to get better quality care with smarter spending from Medicare," said CMS Acting Administrator Andy Slavitt.  "The Independence at Home Demonstration is one of the tools of the Affordable Care Act that can bring down the long-term cost of care in a patient-centered manner."

The CMS analysis found that Independence at Home participants saved over $25 million in the demonstration’s first performance year – an average of $3,070 per participating beneficiary – while delivering high quality patient care in the home.  CMS will award incentive payments of $11.7 million to nine participating practices that succeeded in reducing Medicare expenditures and met designated quality goals for the first year of the demonstration.  

According to CMS’ analysis, all 17 participating practices improved quality in at least three of the six quality measures for the demonstration in the first performance year. Four participating practices met all six quality measures. Medicare beneficiaries who are participating in Independence at Home practices, on average:

• Have fewer hospital readmissions within 30 days;
• Have follow-up contact from their provider within 48 hours of a hospital admission, hospital discharge, or emergency department visit;
• Have their medications identified by their provider within 48 hours of discharge from the hospital;
• Have their preferences documented by their provider; and
• Use inpatient hospital and emergency department services less for conditions such as diabetes, high blood pressure, asthma, pneumonia, or urinary tract infection.

The Independence at Home Demonstration provides chronically ill Medicare beneficiaries with primary care services in the home setting. In the first performance year, 17 participating practices served over 8,400 Medicare beneficiaries.  

The Independence at Home Demonstration is part of the innovative framework established by the Affordable Care Act to move our health care system toward one that rewards doctors based on the quality, not quantity, of care they give patients. The Administration earlier this year announced the ambitious goal of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent of payments by 2018.

To learn more about the Independence at Home Demonstration, including individual practice results, visit: http://innovation.cms.gov/initiatives/Independence-at-Home/.  

Just follow the money

"Stakeholders in the healthcare landscape have begun to see a new emphasis on coordinating care, improving quality while reducing costs and managing the chronically ill, high-cost patients that are currently responsible for the majority of total healthcare spending in the United States", Chip Measells, Investment Banker, of Washington, D.C., April, 2012

The fact of the matter is--25% of the patients generate 83% of the costs in home health.

My friend Jim Pyles says, if you want to understand the way healthcare in the USA is being directed, just follow the money. In our money driven system this is sound as an analytical principle.

How will Value Based Reimbursement shape the way money flows in and out of healthcare?
Here are some trends that indicate the future of healthcare that I believe are becoming indicative of the future of the segment called US healthcare.

• The patient comes first
• Patient satisfaction/ consumer feedback and 'crowd sourcing' of technologies, solutions, and "cures" or therapies- will create 'movements' and tribes/ followers, all who act as experts due to their experiences, will become more pervasive as the Boomers "command the system to meet their needs".
• I love the quote attributed to Truett Cathey, the founder of Chic Filet, when asked what his geographical expansion plans were, he replied," wherever our customers tell us to go". 
• Wherever the boomers want their healthcare, that will influence the way the system provides healthcare delivery. Boomer preference will most likely be --if healthy and ambulatory, in the community(Urgent care/Minute Clinic), and the chronically ill who are not as ambulatory, will prefer home to hospital.
• Cost is the key driver
• Today, insurers are beginning to "follow the money" and recognize that not only that their beneficiaries PREFER home centered care, but that it is the most cost effective method of healthcare delivery. Not hospitals, not rehab, not community clinics, not skilled nursing centers(nursing homes).
• Systems will just ask the patient their preference...and they will prefer close to home, which happens to be the lower cost delivery system, due to its convenience.
• Nurse practitioners will finally be recognized as the most effective PCP in the system, and states will finally look past the AMA and get the NP's approved.
• Teams of Professionals must collaborate and coordinate
• In order to effect change in the costs of care, chronic patients must be directly cared for by Cross Disciplinary Care Teams, who each apply their skills in a technologically streamlined delivery system. 
• This Collaborative leadership emphasizes an intuitive capacity for patient satisfaction, empathy, and requires skills of organization, communication, technological sophistication, political savvy, and systems thinking.
• Social work's influence and skill sets are more and more important in bringing doctors, nurses, administrators, caregivers. families, and patients together to bring about the Triple Aim. The Independence at Home Innovation Model may be the answer for a care model.
• The Feds will tighten their regulatory structure. 
• They are pushing towards getting good press. Cost savings is good public relations for the Feds. yet, government sector costs...don't stop growing.
• Bureaucracies are like glaciers in the ice age, they grow, without any one noticing they're moving at such a steady pace. Look back 50 years, and look what has happened, resulting in what we know as CMS(Center for Medicare/Medicaid Services).
• Insurance will follow the government's coding system( ICD-10) and will set the standards for Value Based Purchasing of Healthcare Services.
• Patient satisfaction, and citing of service quality experience online is a big and increasingly important component
• Those system operators who establish a strong, shared vision and positive "patient experience focused culture", and have a very sharp eye for cost effective processes, will operate in a sustainable manner. 
• Some will optimize and perform better than others, and some won't, like always.

These are but a few of the things that should work themselves to a position of leading importance as this "sea change" of healthcare reorganization continues to permeate. The complexities are immense and the stakes are high. Let's participate in being the systems thinkers would help steer the industry in the best alternative future state reality.