As a part of the Value Based
Purchasing Program that went into effect in 2012, certain hospitals saw their
Medicare reimbursement rates cut, due in part to high patient readmission
rates. The program, reported by NAHAM News in November (Curbing Medicare Spending Begins with Hospital Readmissions), reduced reimbursement rates up to a 1% this year, but
could lose up to 3% in reimbursements in October of 2015.
The focus on readmissions signals a
shift in mentality to cost savings, as well as patient wellbeing. On average, one in five Medicare patients
returns to the hospital within 30 days of being discharged, a fact which cost
the program $17.4 billion in 2004.
The reimbursement rate penalty sent
hospitals looking for ways to reduce readmissions. One popular method was to
set up a network of services that Medicare patients could utilize in their
community, as opposed to just at the hospital. In a pilot program, the Centers
for Medicare and Medicaid Studies (CMS) implemented this approach by
contracting with Quality Improvement Organizations, or QIOs. These organizations
are private groups in each state ad U.S. territory that are comprised of health
care providers and other medical professionals, social service workers, and
other community members.
A study on the
effectiveness of the QIOs, conducted over the course of 2 years, found that the
organizations reduced 30-day hospital readmissions by an average of 5.7%. The
study was reported on by Kaiser Health News, and was
conducted across 14 economically and demographically diverse communities that
used various intervention methods.
At these rates, the average community of 50,000 Medicare
beneficiaries could see a savings in $4 million on readmissions alone.
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