Affordable Care Act’s Provisions to Reduce Preventable Medicare Patient Hospital Readmissions are a Continued Success

The Affordable Care Act put several programs into place to curb Medicare beneficiaries readmission rates. The readmission rate, a measurement of how many patients are readmitted to the hospital within 30 days of initial discharge, is viewed as an indicator of the quality of care a hospital provides. 

The Centers for Medicare & Medicaid Services (CMS) reported that the average avoidable readmission rate for Medicare beneficiaries under 18% from January - August 2013. This is less than the 19% readmission rate that was the standard for the previous five years.  A 2012 study found that readmission rates were on a decline in 2012. The 2013 preliminary claims data combined with the 2012 data results in an estimated 130,000 fewer hospital readmissions from 2012-2013.

CMS attributes the decline in readmission rates to the improved care programs such as community-based care transition plans and payment incentives such as the Hospital Readmissions Reduction Program helped foster. 

More information on the CMS blog is available here. The study that determined Medicare readmission rates had a meaningful decline is available here. Information on the Hospital Readmissions Reduction Program is available here. 

Many Hospitals Concerned about Final CMS Payment Rules

The Centers for Medicare and Medicaid Services (CMS) announced a final rule for hospital outpatient services, or the Outpatient Prospective Payment System (OPPS), this November. The CMS estimates that the rule will increase payments for hospital outpatient departments by 1.7 percent. The new rule will be effective January 1, 2014; however, CMS will delay implementation and final configuration of the new 29 comprehensive APCs until 2015.

The rule will create 29 comprehensive Ambulatory Payment Classifications (APCs) to handle payment for device-dependent services and will require direct supervision for a range of outpatient services in critical access hospitals (CAHs). 

This rule combines five payment codes into a single payment code that covers all outpatient clinic visits. The outpatient clinic visits code will include drugs, biologicals, and radiopharmaceuticals used in a diagnostic test or surgical procedure, lab services and device removal procedures. The American Hospital Association believes that the payments will be well below the cost of treatment for complex patients.

The Access to Medical Imaging Coalition is concerned that the rule will dramatically reduce the outpatient payments to hospitals for CT scans and MRI services. The group is concerned because the rule will establish similar reimbursement rates for a CT scan and x-ray image of the same body part even though a CT scan requires more expensive equipment and is more expensive to adminster. 

Many hospitals are concerned about being able to implement the changes required by the rule by January 1, 2014, the date the rule becomes effective. 

Enrolling for Coverage in Health Insurance Marketplaces: Tax Credits, Fraud, and the IRS

Many individuals will qualify for tax credits to purchase the required health insurance from the health insurance marketplace in 2014. The Internal Revenue Service is responsible for calculating the tax credits accurately. 

The IRS will use a software program to verify tax credit calculations and assess penalties prior to issuing them to health insurers. However, there is concern about fraud because the agency has not completed a fraud mitigation strategy to prevent people that underestimate their incomes from fraudulently collecting health subsidies. As currently established, the IRS would issue the tax credits prior to verifying income.


The IRS has outlined tax provisions related to the Affordable Care Act here.

The report from the Treasury Inspector General for Tax Administration is available here. 

Public Health Experts on High Alert with Recent Rise in Spread of Infectious Diseases

A significant decline in immunization rates in the past few years has resulted in a dramatic increase in the number of documented cases of infectious diseases previously thought to be virtually eliminated in the United States has risen considerably. Falling immunization rates are attributed to fears that vaccinations can cause autism that are based on flawed studies that have been discredited.

Public health officials are seeing a rise in diseases such as measles and pertussis, commonly known as whooping cough. Measles was declared "eliminated" in the United States in 2000. This year alone there were 161 cases of measles reported across 16 states. While this increase does not suggest a widespread outbreak throughout the nation, it does present local and state public health systems with the new challenge of identifying and responding to a disease outbreak with shrinking budgets. 

Experts explain that the spread of measles in the US is generally traced to individuals who contract the disease outside the United States and then infects people exposed to the disease who were not vaccinated. For example, in Tuscon, Arizona a Swiss woman who had been traveling in Mexico arrived in an emergency room with measles. It took two days for her to be diagnosed and placed in isolation. During the two-day period before her isolation she infected an unvaccinated hospital staffer and an 11-month-old child who was too young to be vaccinated. The final count of infected individuals was 14 confirmed cases and 363 suspected cases that were a result of exposure to the Swiss traveler's measles. Seven of the 14 confirmed cases were contracted while the individuals were in the care of hospitals for other medical conditions. 

Preventing the Spread of Infectious Disease

• Early Detection Systems 
• The Department of Homeland Security recently announced plans to create a real-time disease outbreak alert system that would conduct hourly searches for reports of infectious diseases worldwide and send early warnings to at risk communities with low immunization rates. 
• Biosurveillance automated monitoring systems could help with the early detection of natural disease outbreaks with modifications such as integrating primary-care physician data with emergency room data.

• Establish Vaccination Policies
• To reduce the risk of spreading contagious diseases and limit the numbers of isolations required, health systems should require all staff to be up-to-date with vaccinations of contagious diseases. 

• Identification and Response
• Early identification of infectious diseases should be a goal of all health systems. 
• Once a case is discovered the health system should immediately alert public health officials and other community health systems to aid in rapid identification and limit exposure.
• Employees should be familiar with the protocols for reporting the infectious disease to local public health officials and health systems.