Reducing the Price of Hospital Readmission

The Hospital Readmission Reduction Program is part of the Affordable Care Act, which has ignited heated debates both for and against the program. The program aims to improve quality of care and lower costs by reducing hospital readmissions for Medicare patients. To accomplish this, hospitals are essentially dinged when patients are readmitted within 30 days of discharge, and these dings turn into financial penalties for the hospitals. As it currently stands, the penalty is one percent of hospital payments, and is set to increase to three percent by 2015.

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So, how are hospitals dealing with this new policy, which took effect in October 2012? To some extent, they may just be accepting the penalties, chalking it up to the expense of doing business. On a more constructive end, some hospitals are assisting patients with their social needs as they transition from hospital to home: providing instruction to patients on how to take their medicine, ensuring patient transportation for medical visits, and helping patients plan for the time when they leave the hospital. In Baltimore, for example, we learned that some hospitals are developing pilot programs to assist patients with chronic health issues to ensure that they stay healthy once they leave the hospital. And for some patients with significant social problems contributing to readmission, such as homelessness and poverty, there are additional resources such as transition guides and the like, who prepare patients for discharge and help stabilize patients once they leave the hospital.

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Of course, many argue that these services are beyond the scope of medical services. What do you think? Could the Readmissions Reduction Program lead the U.S. healthcare system on a path to further reform, where social and medical issues are addressed in a more integrated manner?

A New York Times article published on March 29th discussed the program and highlighted hospital concerns on these new rules. Critics of the program argue that it negatively affects hospitals serving large academic medical centers, those serving predominately low-income patients, and those treating the most severely ill. Authors of an article published in the New England Journal of Medicine (March 2013) stated that the readmission program could actually create disincentives to providing care to patients with greatest need. Because hospital mortality rates are not factored into the current program, it goes on to say that hospitals with higher mortality rates are able to report lower readmissions. Is this fair? How do you think this affects patient quality of care? What role can evaluation play here?

According to federal analyses, the program has reduced hospital readmissions and costs. However, risks for hospital readmission are multifaceted. The chief executive of the Robert Wood Johnson Foundation was quoted in the New York Times article saying there isn't a single magic bullet to fix everything. Evaluation research is needed to help us better understand if the measures hospitals are taking are effective. It seems that much effort has been placed on outcomes without understanding the processes that lead to those outcomes.

References:

New York Times article:

 https://www.nytimes.com/2013/03/30/business/hospitals-question-fairness-of-new-medicare-rules.html?pagewanted=all&\_r=0\#comments

New England Journal of Medicine article:

 https://www.nejm.org/doi/full/10.1056/NEJMp1300122