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Ohio Needs to Change Reimbursement Rates for Unnecessary Hospital Readmissions – 10/22/14

By: Cathy Levine, Executive Director, UHCAN Ohio.

 

Ten years ago, my mother was readmitted to a suburban New York hospital after shoulder surgery, for a urinary tract infection caused by the catheter used during surgery – considered a preventable infection (they then made her very sick from a test she probably didn’t need). That was my introduction to hospital readmissions for Medicare patients. 

 

A recent Columbus Dispatch article reported that Central Ohio hospitals are paying higher penalties to Medicare, because their readmission rates are not improving at the rate Medicare wants. What’s going on and what do consumers need to know?

Nationally, almost 20% of Medicare patients who are hospitalized are readmitted to the hospital within thirty days for reasons connected to the original admission. Hospital readmissions cost Medicare $17 billion per year – spending that’s largely preventable with better care. But hospital readmissions brought increased revenues to hospitals and taking steps to prevent readmissions cost hospitals money. So, hospitals had financial incentives to maintain the status quo of – until now.

Readmissions happen for several reasons besides hospital-caused complications. A big culprit is inadequate transition planning – for instance, sending a frail older adult home without making sure home care is provided to support recovery. To prevent readmissions, hospitals have to look out for patients after they leave the hospital – either by providing follow-up care or coordinating that care with community-based providers or nursing homes.

To reduce readmissions rates among older adults, Ohio’s Area Agencies on Aging in several regions have established transitions programs using a national model with demonstrated effectiveness.

Another tool for reducing readmissions is the model of enhanced primary care – the so-called “Patient Centered Medical Home,” which is a medical practice that coordinates patient care across settings. PCMH patients who are discharged home from the hospital should expect their doctor’s office to coordinate the patient’s home care.

Medicare’s system of penalties based on unacceptable readmission rates is spurring improvements in patient care and saving money. Why not do the same for Medicaid and privately insured patients? Community Catalyst created model legislation that adjusts payments based on rates of readmissions and other preventable harm. Versions of this legislation is in effect in several states to improve patient safety while saving money.

UHCAN Ohio and Ohio Consumers for Health Coverage have recommended to the Kasich administration that they adopt a similar reimbursement system to reduce readmissions. They received legislative authority to implement it in Medicaid. How much longer must consumers wait?

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