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.
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