Source of readmissions: hospital admissions, not discharge planning

Source of readmissions: hospital admissions, not discharge planning:
Hospitals in areas that have high admission rates also have a high propensity for readmission rates, according to a study published today in the New England Journal of Medicine.

Researchers at Boston's Harvard School of Public Health found that high readmission rates in certain regions of the country don't necessarily have to do with the severity of the patients' conditions or quality of care, but rather, the overall use of hospital services. Researchers looked at readmission rates for discharged patients with congestive heart failure and pneumonia across different regions. The biggest factor in variations between readmission rates, they found, was overall hospital admission rates.

"This is a very important observation that has been largely unrecognized in the literature or by policy makers," lead study author Arnold Epstein, professor and chair of the department of health policy and management at the Harvard School of Public Health, said in a press release yesterday. "Hospitals may have limited ability to reduce readmissions. The responsibility for readmissions lies with the entire delivery system. Meaningful progress may require incentives directed at that level and a change in culture."

Epstein and other researchers based the study on what they think is a weak connection between discharge planning and readmission rates, reports Cardiovascular Business. In light of reimbursement penalties for high readmission rates, hospitals have placed increased emphasis on improving the discharge process in hopes of cutting down on repeat hospitalizations--even going as far as calling it an "unfunded mandate," as New York's Mt. Sinai Hospital Administrator Claudia Colgan described it in a Kaiser Health News and NPR article. Supporters of transitional care have praised improvements in discharge planning under the assumption that it can, in fact, reduce readmission rates. However, the study notes that high readmission rates have more to do with the overuse of inpatient hospital services, according to HealthDay.

"This is about more than just how we discharge patients and follow-up, but about what happens to patients before they get admitted to hospitals," Dr. Bradley Sherman, chairman of the department of medicine at Glen Cove (N.Y.) Hospital, commented on the study. "I think the interesting part of this article is there is so much effort put on the discharge process, but this falls in the gap. Not a lot of people are looking at the other side of this, how the admission process affects readmission rates."

To learn more:
- read the press release
- here's the study abstract
- read the Cardiovascular Business article
- here's the Kaiser Health News and NPR article
- read the HealthDay article
- check out the Consumer Reports article

Related Articles:
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Demand for health IT professionals continues to rise

Demand for health IT professionals continues to rise:
There is a significant demand for health IT professionals with medical experience, says a new report from MedZilla.com, a job site specializing in healthcare and life sciences. MedZilla estimates that 50,000 new health IT-related jobs have been created since the passage of the HITECH Act in 2009, which authorizes billions of dollars in incentives for showing Meaningful Use of electronic health records.

The Bureau of Labor Statistics a few months ago projected that health IT jobs would increase by 20 percent annually through 2018. That predicted increase is far above the average for any other occupation. Since 2009, a Computerworld survey found, the number of health IT jobs has risen by 67 percent.

Dale Johnston, manager of client relations at MedZilla, believes the explosion in health IT jobs shows what happens when two industries come together. "Health IT is a perfect example of this," he said in the report. "Here you have two, previously separate industries that are rapidly growing into one another. Where the two meet you have an opportunity to explore a completely new labor pool."

MedZilla cited positive trends that will continue to support the need for more health IT personnel. Among them are the doubling in the adoption rate of EHRs since 2008, and the decision by the Department of Health & Human Services to postpone the introduction of stage 2 of Meaningful Use to 2014. The latter move is intended to accelerate the spread of EHRs, which is likely to lead to more job creation.

To learn more:
- read the MedZilla.com announcement
- see the Healthcare IT News article

Related Articles:
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Four Common Drugs Seniors Use Cause the most Hospitalizations Annually (60K)

Drugs Seniors Use Most Often Cause 60K Hospitalizations Annually:
News outlets are reporting on a new study that challenges conventional wisdom about seniors, their medicines and hospitalizations.

USA Today/HealthDay: Four Common Meds Send Thousands Of Seniors To Hospital
An estimated 100,000 older Americans are hospitalized for adverse drug reactions yearly, and most of those emergencies stem from four common medications, a new study finds. The four types of medication -- two for diabetes and two blood-thinning agents -- account for two-thirds of those drug-related emergency hospitalizations. "Of the thousands of medications available to older patients, a small group of blood thinners and diabetes medications caused a high proportion of emergency hospitalizations for adverse drug events among elderly Americans," said lead study author Dr. Daniel Budnitz, director of the U.S. Centers for Disease Control and Prevention's medication safety program (Goodwin, 11/25).

The New York Times: Four Drugs Cause Most Hospitalizations in Older Adults
All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. ... Some require blood testing to adjust their doses, and a small dose can have a powerful effect. Blood sugar can be notoriously hard to control in people with diabetes, for example, and taking a slightly larger dose of insulin than needed can send a person into shock (O'Connor, 11/23).

Medscape: 4 Drugs Cause Most Adverse-Event Hospital Stays for Seniors
In contrast, medications red-flagged as high risk or inappropriate by health authorities explained only 1.2% and 6.6%, respectively, of such hospital admissions. ... Hospitalizations arising from [adverse drug events] promise to increase "as Americans live longer, have greater numbers of chronic conditions, and take more medications," the authors note. Lowering the number of such hospitalizations, they write, is a major priority of a federal initiative called Partnership for Patients, which was launched in April. (Lowes, 11/23).

The Wall Street Journal: Common Drugs the Culprit in Most ER Visits by Seniors, Study Finds
The findings suggest that hundreds of millions of dollars could be saved annually by improving the education and drug management of people with certain chronic conditions. The study comes as the government is pushing a major initiative to reduce repeat hospitalizations by 20% by the end of 2013. ... "We need to focus on those areas where we can have the greatest potential to reduce hospitalizations and health care costs," said [Budnitz]. ... Drug-related hospitalizations are expected to grow as people live longer, chronic conditions spread to more of the population and seniors take more types of medications (Martin, 11/25).

WebMD: Most Drug-Related Hospitalizations Due to Handful of Drugs
Patients or their caregivers can do a lot to minimize the risk of a bad event related to a medication, [Michael Cohen, president of the Institute for Safe Medication Practices] and Budnitz say. ... Be sure the right drug name is on the label. Check that it is the strength prescribed for you. Report back to your doctor for blood tests when told to do so. ... Do not take other medicines without discussing them with your doctor (Doheny,11/23).

Don't limit risk-adjustment training to your hospital's IT staff

Don't limit risk-adjustment training to your hospital's IT staff:
With upcoming changes under health reform and pressures to gain revenue, healthcare institutions must make risk-adjustment training a must for all stakeholders, according to Joy Ridlehuber, senior clinical training specialist at Fort Worth-based Leprechaun, LLC, which outsources hierarchical condition category (HCC) management solutions for Medicare advantage plans.
"You really must have a training program no matter what type of organization you are," Ridlehuber said at the Opal Events' Medicare Advantage Strategic Business Symposium in Arlington (Va.) on Tuesday. Risk-adjustment training applies to the small practice all the way up to the large institution, she added.
In addition, training shouldn't be isolated to only staff in coding, health information management, or IT; it must be expanded to providers, care management, client services, and vendors, as well. For example, Ridlehuber said, an IT professional might not have a healthcare background, or vice versa.
"Risk adjustment translates to higher reimbursement with more specific documentation," Ridlehuber said. "You don't want to leave money on the table when you need that to care for members," she added.
In addition, Medicare Advantage members will increasingly play a role in reimbursement as they provide feedback for the 5-star quality rating system mandated in 2010. With ICD-10 pressures and EMR transitions coming down the pike, education seems to be an absolute necessity.

Among the key points to include in risk-adjustment training:

• "Every year, CMS wipes the slate clean on Jan. 1," Ridlehuber said. That means, that organizations must submit diagnosis at least once every year for chronic condition patients.
• Documentation must reflect face-to-face visits for claims to be substantiated.
• On every page of documentation, it must have a patient identifier (e.g., name, ID number), date of encounter, valid signature (written or electronic but not stamped), providers' credentials to distinguish (for example, who is a physician versus a nurse practitioner), and date of signature.
• If signatures are electronic, then the documentation must include the proper regulation-approved language surrounding electronic signatures.
• Providers are reimbursed on CPT codes, and Medicare Advantage reimburses on diagnosis codes

Training can take many forms--in the classroom, online, or self-study. The important takeaway is that the training happens, Ridlehuber said.

Who will be the final 30 ACO Pioneers?

Who will be the final 30 ACO Pioneers?:
With accountable care organization (ACO) Pioneers to launch before the year's end, Centers for Medicare & Medicaid Services (CMS) announced this week, the industry is waiting to hear who the final 30 ACO Pioneers will be. To some surprise, it wasn't Mayo Clinic, Cleveland Clinic, Geisinger Health System, and Intermountain Healthcare, who were among the most likely candidates to join the ACO experiment. The leading health systems, along with others in the industry, complained the draft CMS rules were too burdensome and didn't offer enough incentive to join the Shared Savings or Pioneer program.

"When the poster boys ask that the posters be taken down, you have a problem," said Michael Millenson, president of Health Quality Advisors LLC, in a Kaiser Health News-Politico Pro article.

The no-thanks approach that Mayo, Cleveland, Geisinger, and Intermountain took signaled similar doubts from physician organizations, such as the American College of Physicians, the American Academy of Family Physicians, the Medical Group Management Association, the American Medical Group Association, and the American Medical Association, who generally gave a thumbs down to the ACO Medicare Shared Savings Program draft rules, the program that will proceed the Pioneer program.
However, even with circulating skepticism around ACOs, anywhere between 30 to 50 organizations have applied to the Pioneer program, according to the Advisory Board Company, reports Kaiser-Politico. Among the applicants are Tucson Medical Center in Arizona, Monarch HealthCare in California, Norton Healthcare in Kentucky, Banner Health in multiple states, Mountain States Health Alliance (multiple states), Hackensack University Medical Center in New Jersey, and Montefiore Medical Center in New York.

For more information:
read the Kaiser Health News-Politico Pro article

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CMS releases final eRx rule

CMS releases final eRx rule:
The Centers for Medicare & Medicaid Services (CMS) on Wednesday announced changes to the Medicare Electronic Prescribing (eRx) Incentive Program for calendar year 2011.
CMS received public comments raising concerns that the Medicare eRx Incentive program did not better align with the Medicare or Medicaid EHR Incentive Program also about the need for additional significant hardship exemption categories.
Among individuals and organizations submitting comments was the American Medical Association.


read more

Q&A: Expert points to IT power of ACOs

Q&A: Expert points to IT power of ACOs

By Healthcare Payer News

06/13/2011

By: Bernie Monegain

Dogu Celebi, MD, is chief medical officer, payer and government solutions at OptumInsights (formerly Ingenix). Before joining OptumInsights, Celebi developed disease and care management programs for CIGNA. He spoke with Healthcare IT News about the role of health information technology in supporting accountable care organizations (ACOs).

read more

CMS unveils new initiatives to kickstart ACO formation

CMS unveils new initiatives to kickstart ACO formation:
While the Centers for Medicare and Medicaid Services (CMS) continues to finalize the proposed rule on creating accountable care organizations (ACOs)--and listens to concerns from providers about their feasibility--it introduced three new initiatives Tuesday to move the accountable care process further along.
CMS said its Center for Medicare and Medicaid Innovation will be accepting applications for the first initiative--the Pioneer ACO Model--which will be available this summer for about 30 experienced organizations that are now working or considering ways to coordinate care for their patients. CMS expects this model to save Medicare about $430 million over three years.
The Pioneer initiative will require groups to work together at a 'more aggressive pace' to see change--in terms of improving health outcomes and savings, said Joe McCannon, senior advisor to the CMS administrator, at a Brookings Institution presentation Tuesday on health systems improvement.
The first two years of the program will have higher levels of shared savings and higher levels or risk compared to what is outlined in the current proposed rule, he noted.
The second proposal, the Advance Payment ACO Initiative, has been introduced in response to organizations that have been worried about the capital needed to create an ACO, McCannon said. The idea is that an 'advance' could be made to an organization for start-up capital investment and infrastructure costs.
'The money would be recouped through the savings that would come going forward,' he said. More details need to be spelled out on how this will work. The Innovation Center is seeking public comments on this approach through June 17.
The final initiative addresses creation of four accelerated development learning sessions. The sessions will be held (beginning June 20) for healthcare providers on what steps they can take to improve care delivery and to create ways to achieve better-coordinated care.
For more details:
- read the CMS announcement
- see the CMS fact sheet on the new options
- view The Washington Post article
Related Articles:
Navigating the pros and cons of ACOs in Medicare Shared Savings Programs
Affordable Care Act to Improve Quality of Care for People with Medicare
Accountable Care Organizations: Draft rules and guidance released by CMS, IRS, OIG, FTC

Inpatient, outpatient healthcare costs have doubled in nine years

Inpatient, outpatient healthcare costs have doubled in nine years:

- Here's the study (.pdf)
Medical inflation is at its most moderate levels in years, but the cost of hospital inpatient and outpatient care continues to outpace the costs of other sector components, according to a new report by actuarial firm Milliman.
The Milliman Medical Index reports that the cost of providing healthcare this year for a four-member household is $19,393, up 6.7 percent, or $1,319, from 2010, but still nearly double the cost in 2002 of $9,235.
'We don't see anything on the near-term horizon that's going to bend that downward,' Milliman principal Lorraine Mayne, one of the study's co-authors, told the Associated Press.
The biggest cost drivers in the past year have been medical care rendered by outpatient clinics and acute care hospitals. Outpatient care costs rose 10 percent, while hospital costs rose 8.6 percent. However, inpatient care contributes 31 percent of the total costs of healthcare delivery, 'the largest single contributor to the 2011 increase in the MMI,' the report said.
Miami, New York City and Chicago saw the largest cost increases over the past year, ranging between 13 percent and 20 percent higher than the nationwide average, while cities such as Phoenix, Seattle and Atlanta experienced increases significantly below average.
For more:
- read the Associated Press article
- here's the study (.pdf)

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Accountable Care Organizations: Draft rules and guidance released by CMS, IRS, OIG, FTC

Accountable Care Organizations: Draft rules and guidance released by CMS, IRS, OIG, FTC: "
When it rains it pours. CMS today released several hotly anticipated goodies related to Accountable Care Organizations. First and foremost, the agency published a 429-page draft that details how CMS would implement section 3022 of the Affordable Care Act, which contains provisions relating to Medicare payments to providers who participate in ACOs.

The agency also published jointly with HHS Office of Inspector General its proposals for waivers of certain Federal laws, including the physician self-referral law, the anti-kickback statute and specific provisions of the civil monetary penalty law.

In addition, the Federal Trade Commission and the Department of Justice jointly issued Antitrust Policy Statement, and the Internal Revenue Service published its take on guidance needed for tax-exempt organizations that participate in ACOs.
For more information:
- read this National Journal report
Related Articles:
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Top 100 hospitals identified for 2011

Top 100 hospitals identified for 2011: "

Russell Medical Center, in Alexander City, Ala.; Northwestern Memorial Hospital in Chicago, Ill.; Ochsner Medical Center in New Orleans and Brigham and Women's Hospital in Boston were among the 100 Top Hospitals identified this week by Thomson Reuters.

The annual ranking "uses objective research and independent public data to recognize the best U.S. hospitals. Hospitals do not apply and winners do not pay to market this honor," Thomson Reuters reports.

Other top performers include NorthShore University HealthSystem in Evanston, Ill., Caritas St. Elizabeth's Medical Center in Boston and American Fork (Utah) Hospital. List

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Counties ranked online on overall health factors

Counties ranked online on overall health factors: "

Healthcare providers interested in finding out where their counties measure up in terms of how healthy their residents are and what factors--ranging from access to healthcare, tobacco use, obesity, employment, safety and air quality--are impacting that health, can examine new online health rankings released today.

'These rankings tell us that where we live matters to our health,' said Patrick Remington, MD, MPH, associate dean for public health at the University of Wisconsin School of Medicine and Public Health, at a March 30 telebriefing. This second annual release of county health rankings was compiled by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.

'The rankings are the only annual checkup for the over 3,000 counties in the nation,' Remington said. The rankings can be used by individuals to compare the overall health of their counties against other counties in their state, and also with top-performing counties nationwide on specific health factors.

Like last year's rankings, researchers used specific measures to assess health outcomes by county: the rate of people dying before age 75; the percentage of people who reported being in fair or poor health; the number of days in poor mental health; and the rate of low-birthweight infants.

Information also was collected on about 25 other factors that affect the health of communities--'information about the quality of healthcare, lifestyles, social and economic factors, and also measures of the environment,' Remington said.

Among the general findings of the study: counties with urban communities are the least healthy in their state; counties with suburbs adjacent to these urban areas are healthier but often have very polluted air and poor environmental conditions; and rural counties often tended to have the overall poorer health factors. 'But it's really important to understand that each county is different,' Remington noted.

For more details:
- see the online health rankings website
- view the County Health Rankings release

Recent Articles:

Urban, suburban areas rank highest in county-specific health outcomes
Reach for the Top Community Health Initiative to Spark Improvements in Health, Care Delivery and Cost

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