NATIONAL HARBOR, Md. -- Medicare is likely in the near future to consider all health conditions when it calculates penalties for not holding down hospital readmissions, quality improvement experts said here Friday.
Under its , the Centers for Medicare and Medicaid Services (CMS) now penalizes hospitals whose patients are readmitted for acute myocardial infarction (MI), heart failure, or pneumonia within 30 days of hospital discharge. In fiscal 2015, CMS has proposed expanding that program to include total knee replacement, total hip replacement, and chronic obstructive pulmonary disease.
But that list could grow even larger and include all-cause readmission, said Jeff Greenwald, MD, who is a teaching hospitalist at Massachusetts General Hospital in Boston.
"[The National Quality Form] has published and has endorsed an all-readmissions metric," Greenwald said at . "I suspect CMS in 2016 will adopt that instead of just being disease-specific."
Mark Williams, MD, chief of hospital medicine at Northwestern University School of Medicine in Chicago, noted CMS will use readmission rates from this year in its calculations for 2016, so providers must act now to cut rates.
CMS uses a 3-year rolling average in its readmissions calculations, making fiscal 2013 the first year it would use, the presenters said.
CMS's hospital readmission program was created as part of the Affordable Care Act. Hospitals having readmission rates in excess of what CMS deems to be acceptable for certain conditions will have all Medicare payments cut by up to 1% in fiscal 2013. That reduction jumps to as much as 3% in fiscal 2015.
About two-thirds of hospitals are incurring penalties and about 10% are losing the maximum penalty, Williams said. The average penalty in fiscal 2013 is estimated to be $126,000.
that readmissions dropped to 17.8% in the last 3 months of 2012 after hovering around 18.5% to 19.5% for the previous 5 years.
Williams and Greenwald also spoke at length about the SHM's Project BOOST -- which stands for .
The project seeks to improve patients' transition from the hospital and back into the community, and reduce readmissions in the process. What started in 2008 with six hospitals has grown to 160 and it appears to be working, the speakers said.
Hospital units using the Project BOOST dropped readmissions from 14.7% to 12.7% after a year, while control, non-BOOST-using units at the same hospital showed no change, Williams and Greenwald said. The study found no change in the length of hospital stay either, Williams said.
The study involved 11 newcomers to Project BOOST. Results will be published this summer in the Journal of Hospital Medicine.
BOOST predicates itself on identifying failed transitions from each hospital, and then uses standardized interventions to improve patient preparation for discharge and ensure access to care after discharge.
Hospital workers do things such as crafting a checklist for patient upon discharge so they know what to do.
"We have a lot of project management tools. We have a lot of team preparation, a lot of cheerleading around culture change, and a lot of engagement with the team to understand that until they make those culture changes, you're going to have a hard time," Greenwald, a co-investigator of Project BOOST said. "You can't just throw a form in front of a system. It takes time."