Industry Experts Explain 3 Methods to Reduce Hospital Readmission (Part 1)

Fines for high readmission rates have been punishing some of America’s hospitals since October first. Many experts in the industry have been working to find solutions to what has become one of the most prevalent issues faced by health facilities today.

Andrew Seaman, with Reuters, suggests that social factors, outside of the reach of any hospital, may be contributing more than CMS is willing to admit.

But CMS does not consider so-called social factors, such as a patient's living situation or low income, when profiling the quality of a hospital's care.

In the new study, published in the Journal of General Internal Medicine, researchers analyzed data from 72 previous papers examining the reasons people died or were readmitted to the hospital, and found that age, race, employment status, living situation, education and income levels are just some of the factors that may play a role.

"We don't yet know how to accurately measure (the factors), but I think we found enough information to say that they are important and that they should continue to be studied and accounted for," said lead author Dr. Linda Calvillo-King, an assistant professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas.

In the Reuters article, Calvillo-King explains that too many factors outside of a hospital’s control -- such as whether or not a patient follows prescription instructions -- are leading to readmission penalties.

Alternatively, in a recent NPR report, Dr. Julie Ann Sosa, of the Yale School of Medicine, believes that patients are simply being released too early after surgery.

"We live in an era where there is a pressure to discharge and to expedite care and make health care more efficient," says Dr. Julie Ann Sosa, a surgery professor at the Yale School of Medicine who co-authored the study. "Some of these complications in the past may have occurred while patients were still hospitalized. Now they occur at home."

Sosa and her colleagues analyzed a database of more than 500,000 patients who underwent surgery from 2005 through 2010. The researchers found that the most common surgical complication patients experience after leaving the hospital is a localized infection at the site of the incision…

…More than 40 percent of all patients who experience complications after surgery experience them at home, according to a study in the journal Archives of Surgery. Half of those complications occur within nine days of patients leaving the hospital.

Next week, we’ll continue delving into these topics, and will open the floor to suggestions on how hospitals should be changing to meet CMS guidelines, or if those guidelines are even plausible.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Video Analysis: Are Healthcare Costs Out of Control?

We recently discovered the following video on Reason.com. The video details a few facts about healthcare costs that most consumers would probably find surprising.

Of course, the high costs of healthcare are nothing new for those of us in the industry. The question that everyone is clamoring to answer is: why?

Reason.com presents a few examples of gross over-pricing in the video, but none is more black-and-white than that of a “complex bilateral sinus procedure.” The procedure was priced at a major hospital, as well as the Oklahoma Surgery Center. The cost difference ends up at just over $27,000, but the patient would never see that bill, and never think to question the markup. Reason explains:

The Integris bill for the same nasal procedure went to Blue Cross of Oklahoma, so the patient had no compelling reason to question its outrageous markups. They included a $360 charge for a steroid called dexamethasone, which can be purchased wholesale for just 75 cents. Or the three charges totaling $630 for a painkiller called fentanyl citrate, which all together cost the hospital about $1.50.

Integris insists that some prices are raised to cover the cost of pro bono procedures, but Reason’s conclusion is that hospitals are intentionally marking up charges for insurance companies and government agencies to pay, knowing that no one is checking the numbers. It’s a shocking and somewhat believable argument, but is it true? Tell us your opinions in the comments section below!

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Do Financial Incentives Really Work?

The cornerstone of President Obama’s efforts to improve the quality of health care in the US is a series of financial incentives. These incentives reward hospitals that meet certain requirements, and punish those that do not.

It is still a controversial strategy, several months after the first of these incentives rolled out. Many experts attacked the president’s plan, citing some fairly obvious reasoning.

The idea that people will be motivated to do better if they are paid more as a result may seem like common sense, but medicine is complex, Himmelstein said. Often the measures used to determine success do not match the conditions of care or patient outcomes the program is meant to address, he said. Himmelstein said other fields have struggled with pay-for-performance programs. Under national education policy, schools that score poorly on standardized tests receive less funding. “They’re the ones who need it most,” he said. “Is the right reaction to poor quality that those institutions need fewer resources, not more?”

A study was conducted in August, measuring the efficacy of financial incentives to quality of care. While the results weren’t purely negative, they also didn’t exactly celebrate the President’s victory.

A review of seven studies of primary care programs that paid doctors extra for meeting certain targets, published by the Cochrane Collaboration in September, was inconclusive about the effect on quality of care. “Implementation should proceed with caution,” the authors wrote.

Other studies were less neutral. The New England Journal of Medicine released results showing that financial incentives for performance “did not reduce short-term patient mortality rates.”

What do you think? Are incentives effective in the long term? Do we need a new national strategy to improve quality of care?

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.