Readmission reduction proposal may have national implications

Through a proposed program to lower hospital readmissions--which accounted for $1.2 billion of $9.0 billion spent across Maryland on hospital care in the last fiscal year--state officials may well provide an example that the rest of the nation can emulate. 

The program, which several hospitals (including the Leapfrog-acclaimed University of Maryland Medical Center) volunteered to join, involves a three-year cap on inpatient care, reports Kaiser Health News. Since Maryland currently is the only state where hospital rates are determined by state regulators, it is the only state where such a pilot could take place. Thus, hospitals with higher readmission rates would lose money, since they could only be reimbursed for so much. 

The thinking is that such a cap would push hospitals to offer higher quality care at a community level. Care managers and nurses were cited as a means for keeping patients healthier outside of a hospital's walls. 

"If readmission rates are to serve as an overall measure of both quality and cost, it is necessary to apply an analytic approach that focuses on those readmissions that could have potentially been prevented," the proposal reads. 

Separate but similar programs would be enacted based on a hospital's size. For example, smaller hospitals would have a target budget for all care--inpatient, as well as outpatient--as opposed to a cap on payments for readmissions," according to KHN

While the proposal so far has been met with relative optimism, some, like Baltimore-based medical doctor Stephen Jencks, worry that such measures could encourage hospitals to try to send problematic patients to rival hospitals. "The first step should not be on the patient's toes," he told KHN

Another concern, shared by Robert Murray, executive director of the Maryland Health Services Cost Review Commission, is that hospitals might hold returning patients in the emergency room, which technically wouldn't count as a readmission. That concern is mentioned in the proposal. 

"If the overall goal of bundled payment initiatives is to reduce overall system utilization and expense, then it is important that reductions in unnecessary readmissions are not accompanied by increases in ED visits, observation cases, and rates of admission for ambulatory sensitive cases," the proposal reads. "Additionally, readmission rates may be influenced by changes in the mix of a hospital's patient population over time. Adjustments to the methodology may be required in the event of a major change to a facility's service mix or mix of indigent patients." 

To learn more:
- read the proposal (.pdf)
- here's the Kaiser Health News piece