Hospital Discharge

Strategies to ensure senior patients are discharged with the tools necessary to manage their health.

Pioneer ACOs Generate Savings to Medicare and High-Quality Outcomes

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Medicare beneficiaries who are in Pioneer ACOs on average report more timely care and better communication with their providers among other benefits.

Medicare beneficiaries who are in Pioneer ACOs on average report more timely care and better communication with their providers among other benefits.

The Pioneer Accountable Care Organization (ACO) Model saved Medicare nearly $400 million in its first two years.

A payment model created under the Affordable Care Act, the Pioneer Model was designed for health systems that are already experienced in coordinating care for patients across care settings to achieve cost savings while delivering high-quality outcomes.

The Pioneer Model generated more than $384 million in savings to Medicare for 2012 and 2013, which is an average of approximately $300 per participating beneficiary per year, according to the Department of Health and Human Services (HHS).

Compared to their counterparts in regular fee-for-service or Medicare Advantage plans, Medicare beneficiaries who are in Pioneer ACOs on average report more timely care and better communication with their providers; use inpatient hospital services less and have fewer tests and procedures; and have more follow-up visits from their providers after hospital discharge, according to HHS’ report findings, as reported by Home Health Care News.

“The [Office of the Actuary in the Centers for Medicare & Medicaid Services’] certification that expansion of Pioneer ACOs would reduce net Medicare spending, coupled with [HHS] Secretary Sylvia Mathews Burwell’s determination that expansion would maintain or improve patient care without limiting coverage or benefits, means that HHS will consider ways to scale the Pioneer ACO Model into other Medicare programs,” HHS said in a statement.

 


Home Health Agencies Protect Referrals by Cutting Hospital Readmissions

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Home health providers take a variety of steps to cut hospital readmissions, such as using checklists to ensure ongoing care coordination with the hospital after the patient has returned home.

Home health providers take a variety of steps to cut hospital readmissions, such as using checklists to ensure ongoing care coordination with the hospital after the patient has returned home.

Home health agencies are outperforming the post-acute sector as a whole in preventing patient rehospitalizations, according to data released Wednesday by the Alliance for Home Health Quality and Innovation, as reported by Home Health Care News/Tim Mullaney.

The numbers suggest that home health providers are taking steps to protect and expand their referral streams from hospitals, Alliance Executive Director Teresa Lee tells Home Health Care News. Since 2012, hospitals have faced Medicare reimbursement cuts if too many patients return within 30 days, meaning they are looking for post-acute providers that can help prevent readmissions.

Between 2011 and 2012, hospital readmissions from home health settings decreased about 2%, from 19.2% to 17.4%, according to the Alliance’s Chartbook report. For the post-acute sector overall, including skilled nursing and other provider types, the 2012 readmissions rate was 18.4%. These numbers were calculated for readmissions within 30 days of discharge, for the top 20 most common diagnosis groups sent to a post-acute setting.

Home health providers have taken a variety of steps to cut hospital readmissions, such as using checklists to ensure ongoing care coordination with the hospital after the patient has returned home.

Given the shifts in Medicare incentives, other types of providers also have sought to decrease rehospitalizations, and there has been a system-wide reduction, Lee notes.

“There is this overall trend, and we’re very pleased to see home health is part of that trend,” she told HHCN.

Still, the fact that home health agencies are performing especially well on readmissions, coupled with the lower costs for home care versus facility-based care, could make HHAs particularly attractive partners for hospitals — particularly those that are part of accountable care organizations and similar provider groups that are financially rewarded for bringing down Medicare spending while meeting quality objectives.

“I hear anecdotally about agencies interacting with ACOs,” Lee says, noting that she does not have hard numbers on home health participation in ACOs. “It does seem to me that within the Alliance membership, there’s a great deal of engagement with ACOs, bundled payments, these different types of programs.”

Lee also points out that the percentage of patients who go from the hospital to home care has remained relatively stable over the past several Chartbook reports. However, she thinks it is reasonable to expect the proportion to increase in coming years. Medicare data does not immediately become available for analysis, so this shift might be underway well before it is reflected in an Alliance Chartbook report, she notes.

Click here to access the complete report, compiled for the Alliance by Avalere Health.

Article courtesy Home Health Care News


Cleveland Hospitals Grapple With Readmission Fines

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By Sarah Jane Tribble, WCPN January 26, 2015 [This story is part of a partnership that includes WCPN/Ideastream, NPR and Kaiser Health News.]

At the Cleveland Clinic’s sprawling main campus, patient Morgan Clay is being discharged.

Clay arrived a couple of weeks ago suffering from complications related to acute heart failure. He’s ready to go home. But before Clay can leave, pharmacist Katie Greenlee stops by the room.

“What questions can I answer for you about the medicines?” Greenlee asks as she presents a folder of information about more than a dozen prescriptions Clay takes.

“I don’t have too many questions,” Clay says. “I’ve been on most of that stuff for a long time.”

Clay is 62 years old and has been on many of the medications since he was in his 20s, when he developed heart problems.

Still, Greenlee wants to make sure Clay understands the importance of taking his pills at the right time and at their full dosage. Not taking medicine correctly is a big reason patients return to the hospital. And research has found that as many as 30 percent of prescriptions are never filled.

Since the Cleveland Clinic began sending pharmacists into cardiovascular patient rooms at discharge, it has drastically reduced its number of readmissions. And that means it has reduced its Medicare fines, mandated by the Affordable Care Act.

But this kind of success in the ACA’s readmissions program, now in its third year, has been hard to achieve for other Cleveland hospitals that serve more poor patients.

This month, the National Quality Forum began a two-year trial period that adjusts Medicare’s metrics to account for poorer patient populations. NQF is a not-for-profit advisory group that works with federal regulators on the penalty metrics. Read more