Lisa Remington’s Series on Accountable Care Organizations: Part IV

The Remington Report‘s Lisa Remington has provided this article special to HCAF that details Accountable Care Organizations, established in the Patient Protection and Affordable Care Act of 2010. This article is part one in a series. For more information about ACOs and other trends impacting the home care industry, consider joining Remington’s Executive Academy on Health Care Reform.

Part IV – Proposed Quality Measures for Accountable Care Organizations
By Lisa Remington, Publisher, The Remington Report

A number of new headlines signify the government’s crackdown on readmissions.

1. The Partnership for Patients is a new public-private partnership that will help improve the quality, safety and affordability of health care for Medicare, Medicaid and CHIP beneficiaries and, by extension, all Americans.  One of the Partnership’s goals is to decrease preventable complications during a transition from one care setting to another so that all hospital readmissions would be reduced by 20-percent by 2014 compared to 2010.  Achieving this goal would mean more than 1.6 million additional patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

The two goals of this new partnership are to:

  • Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over three years.
  • Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

2. Hospital Payments In Fiscal Year 2012 – The proposed rule proposes measures for rates of readmissions for three conditions — acute myocardial infarction (or heart attack), heart failure, and pneumonia.  CMS is also proposing a methodology that would be used to calculate excess readmission rates for the program.  Additional conditions may be added in future rulemaking.  The payment adjustments will apply to hospital payments in FY 2013, beginning with discharges on or after Oct. 1, 2012.

These two announcements begin the footprint for all providers across the healthcare delivery system. Readmissions is a common cause that all providers can participate in. It is the foundation for shared savings. It fundamentally works with payment reform: bundled payments, global payments, etc. for all providers. It begins health care reform

Managing unplanned readmissions expands collaborative solutions across the care delivery system:

  • Hospitals/ health systems/ACos
  • Physician medical groups and medical homes
  • Case managers
  • Hospitalists
  • ER
  • Discharge planner
  • Nursing homes
  • Home care
  • Retail clinics
  • Skilled nursing facilities
  • Rehab facilities

Home care has a window of time to position, clinical integration, case management, care transitions, and technology as a key solution for avoidable hospital readmissions. I am emphasizing “window of opportunity.” WHEN REIMBURSEMENT IS TAKEN AWAY, HOSPITALS WILL HOVER OVER PATIENTS AFTER THE 30-DAY DISCHARGE. With that said, home care can strongly position service and solutions. I’m just throwing out a fair warning here – there is already evidence of  readmission programs that are successful without using home care. That should not prevail as the model of the future.

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