Legislation would factor patient finances into readmission penalities

The Senate introduced legislation this week that would require Medicare to consider patients' finances when deciding whether to punish a hospital for readmission numbers.

The bill, sponsored by both Democrats and Republicans, aims to help hospitals that serve large numbers of low-income patients. It does not specify how to revise the penalty program--leaving it up to Medicare.

The program will put up to 3 percent of a hospital's Medicare payments at risk and expand the number of conditions it bases the assessment on to include chronic obstructive pulmonary disease, and total hip and knee replacements, according to Kaiser Health News.

Hospital groups across the country support the legislation, including the American Hospital Association, as well as the National Quality Forum. "While we absolutely agree that hospitals should do all within their power to reduce readmissions, the existing program penalizes hospitals for factors beyond their control, and takes away critical resources from the hospitals and patients that need them most," AHA Executive Vice President Rick Pollack wrote in a letter of support for the legislation. 

Atul Grover, chief of public policy for the Association of American Medical Colleges, told Kaiser the legislation "recognizes there are hospitals that maybe are providing excellent care that isn't reflected in the way the readmissions measures are reported."

Meanwhile, researchers found that administrative billing data, used to measure readmissions and in turn penalize hospitals, does not reliably describe the reason for readmission, according to a study published in JAMA Surgery this month.

Of the 315 hospital readmissions examined in the retrospective study, the readmission diagnosis listed in the administrative claims differed from the clinical diagnosis in 97 readmissions (30.8 percent.) Readmission measures identified 15 readmissions as planned, whereas clinical data identified 43 readmissions as planned. Unrelated readmissions made up 70 of the 258 unplanned readmissions, according to the study.

While legislators and Medicare try and figure out new readmissions measurements, hospitals across the country work to drop their numbers through new initiatives in care coordination, targeting high-risk patients and new technologies, the Huffington Post reported.

Western Maryland Health System in Cumberland offers bedside prescription delivery through a local pharmacy, as well as hospital pharmacists that educate patients on medication management and adherence. At St. Johns Hospital in Springfield, Illinois, nurses monitor high-risk heart failure patients remotely with telescales that actually "talk" to patients, asking them basic health questions, and transmitting data directly to screens monitored by the nurses, according to the article.

To learn more:
- read the bill (.pdf)
- here's the AHA letter (.pdf)
- see the Kaiser article
- read the Huffington Post article
- check out the study