Not budg­ing

Good news hard to find in 30-day read­mis­sions data

Modern Healthcare - - THE WEEK IN HEALTHCARE - Maureen Mckin­ney

Newly updated 30-day read­mis­sions data posted to the CMS’ con­sumer web­site shines a spot­light on a few higher- and lower-per­form­ing hos­pi­tals while re­veal­ing lit­tle progress na­tion­ally.

The Hospi­tal Com­pare up­date comes not long be­fore the CMS is sched­uled to be­gin an ag­gres­sive pro­gram to curb pre­ventable re­hos­pi­tal­iza­tions. On Oct. 1, the agency will launch its read­mis­sions re­duc­tions pro­gram, an ini­tia­tive that will pe­nal­ize in­pa­tient hos­pi­tals whose read­mis­sions rates put them in the bot­tom-per­form­ing quar­tile of hos­pi­tals in the na­tion.

Florida Hospi­tal, a 2,083-bed fa­cil­ity in Or­lando, was among eight hos­pi­tals des­ig­nated as hav­ing “worse than expected” rates of hospi­tal read­mis­sions for all three con­di­tions— heart fail­ure, heart at­tack and pneu­mo­nia— re­ported on Hospi­tal Com­pare. That’s de­spite sev­eral years of try­ing to im­prove dis­charge-plan­ning pro­cesses and con­ti­nu­ity of care, said Rich Mor­ri­son, the hospi­tal’s se­nior vice pres­i­dent of gov­ern­ment and pub­lic af­fairs.

Based on data from its own in­ter­nal track­ing sys­tem, Florida Hospi­tal expected to be among the low per­form­ers for heart at­tack and heart fail­ure read­mis­sions, but be­ing in­cluded for pneu­mo­nia as well came as a sur­prise, Mor­ri­son said.

Mor­ri­son ar­gued that too much of the burden—and the fi­nan­cial penal­ties— as­so­ci­ated with read­mis­sions are be­ing placed on hos­pi­tals. “We ought to be held ac­count­able for what we can con­trol, but it is not rea­son­able, in our opin­ion, to be held

re­spon­si­ble for what we can’t,” he said. “I have no con­trol over what hap­pens in nurs­ing homes or in home care. We need to have the in­cen­tives aligned so there is ac­count­abil­ity on those seg­ments of the health­care con­tin­uum.”

The com­ing penal­ties, cal­cu­lated us­ing hos­pi­tals’ “ex­cess read­mis­sion rates,” will top out at 1% of base oper­at­ing DRG pay­ments in fis­cal 2013, 2% in 2014 and 3% in 2015.

Al­though the time­frame used for the read­mis­sions re­duc­tion pro­gram—July 1, 2008, though June 30, 2011—is the same as the pe­riod cov­ered in the Hospi­tal Com­pare up­date, CMS of­fi­cials cau­tioned that one could not be used to pre­dict the other.

“The cal­cu­la­tions that will be used for the hospi­tal read­mis­sions re­duc­tion pro­gram will be dif­fer­ent,” the CMS said in e-mailed com­ments. The CMS con­fi­den­tially told hos­pi­tals the rates un­der the read­mis­sions pro­gram about a month ago, the agency said.

Florida Hospi­tal fully ex­pects to be in­cluded in that bot­tom-per­form­ing quar­tile and has ad­justed the an­tic­i­pated penalty into its yearly bud­get ac­cord­ingly, Mor­ri­son said. “We have made progress, but I don’t think you’ll see our num­bers move on Hospi­tal Com­pare for an­other year and half or so be­cause these prob­lems are so com­plex,” he said.

Also among the eight hos­pi­tals rec­og­nized on Hospi­tal Com­pare as per­form­ing worse than expected on read­mis­sions across all three con­di­tions were Beth Is­rael Dea­coness Med­i­cal Cen­ter, Bos­ton; Henry Ford Hospi­tal, Detroit; and Olympia Med­i­cal Cen­ter, Los Angeles. Beth Is­rael Dea­coness and Olympia, how­ever, scored “bet­ter than expected” on mor­tal­ity for all three con­di­tions, and Henry Ford did so for two con­di­tions.

“There seems to be a na­tional phe­nom­e­non whereby many hos­pi­tals that per­form well on mor­tal­ity rates at the same time are chal­lenged to do well on read­mis­sions,” said Dr. Ken­neth Sands, Beth Is­rael Dea­coness’ se­nior vice pres­i­dent of health­care qual­ity. “It’s not en­tirely clear what the re­la­tion­ship is and what drives it.”

Sands added: “If we were to choose which one to be stel­lar on, though, it would be mor­tal­ity.”

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.