Starting in fiscal year 2012 (October 2011) – as part of the Affordable Care Act of 2010 – hospitals will lose 1% of their total Medicare inpatient payments if certain benchmarks on patient readmissions aren’t achieved within the first 30 days after discharge for three high-risk conditions:
Congestive heart failure
Acute myocardial infarction (AMI)
By fiscal year 2017, the percentage of Medicare payments lost will rise to 2%. The number of conditions covered by these penalties may also be expanded in fiscal year 2013 to include four additional diagnoses – chronic obstructive pulmonary disease (COPD), post-surgical coronary artery bypass graft (CABG), post-surgical percutaneous transluminal angioplasty (PTCA), and other post-surgical vascular conditions.
Needless to say, these regulations have hospitals scrambling to revamp their policies and procedures in order to avoid the penalties, since they could easily wipe out a substantial portion of a hospital’s bottom line and threaten their survival.
Hospitals are looking for assistance, and home health and hospice can help. Here’s your opportunity to get a C-level meeting with those who will be the Home Care Services brand decision-makers in the future.
Preparing for the Meeting
We have developed a worksheet to help you get ready for this important meeting. Click here to download the worksheet now. Then, complete the information in the worksheet and answer the following questions:
1. Does the hospital have a readmission issue? If so, how much?
If the readmission rate for a particular clinical condition is above the national 50th percentile, the hospital should be concerned.
2. How well does the hospital use home health when benchmarked?
If the hospital’s referral rate to home health is below that of the top performers, then it’s not using home health to its fullest to prevent re-admissions.
3. Does the hospital have unnecessary readmission risk because it sends more patients to community or self-care than it needs to?
If the hospital refers more patients to community care (no care) for a given diagnostic related group (DRG) compared to the top performers, then it’s being exposed to increased readmission risk.
4. Does the hospital encourage patients to use the facility as their place of death?
If the death for congestive heart failure (CHF) is greater than the expected mortality, the hospital is likely readmitting patients to die in their facility.
5. How well does the hospital use hospice when benchmarked?
If the hospital’s referral rate to hospice is below that of the top performers, it’s not referring as many individuals to hospice as it could and risking unnecessary re-admissions.
6. How well does your home health agency minimize readmissions and the use of emergent care?
If the readmission rate and use of emergent care is greater than the state average on Home Health Compare, then the agency needs to decrease these two metrics.