December 16, 2014
By Joanne Lynn M.D.
Director, Center for Elder Care and Advanced Illness, Altarum Institute
Medicare’s hospital penalties and other programs appear to be penalizing some of the very best performers in the country! We have now posted the data from San Diego County, showing that the Medicare fee-for-service beneficiaries in San Diego use hospitals much less than the national average, they come back within 30 days much less often, and the work on care transitions in San Diego is continuing to drive hospital use and re-hospitalizations down. Our comrades in San Diego should be getting accolades. Instead, 10 of the 14 eligible hospitals in San Diego are getting penalties.
The data show why: Medicare’s metric calculates the risk of readmission “per discharge,” but the improvements that reduce that risk also reduce the risk of being back in the hospital long beyond the 30 days. When you cut the numerator and the denominator together, the ratio can stay the same. That’s what’s happening in San Diego and elsewhere.
We don’t know how many places are affected, but we have a hunch that there are quite a few, and there will be more as good care transitions practices become widespread. Steve Jencks has posted an accompanying essay that delves into the concepts and corrections in more detail. The Centers for Medicare & Medicaid Services (CMS) should quickly figure out how to stop penalizing high performers. The current practice violates basic requirements of fairness. CMS also should start developing better metrics that can guide improvement activities into the future.
Persons concerned about health care system reform for Medicare should be aware of this issue, help us keep the discussion focused, and push for appropriate reforms. The work on care transitions has been remarkably effective in building continuity into the care of people moving into and out of hospitals. The trick now is to build the metrics that we need without slowing the pace of improvement.
Want to Learn More?
For the San Diego data see:
For the essay by Stephen Jencks giving more of the context see:
MediCaring® is the exciting idea that Americans can learn to build reliable, effective, and efficient arrangements for services to support one another when we face the serious chronic conditions associated with very old age or the last years of life-and that such a care system will be quite different from the one we have now.
At the Center for Elder Care and Advanced Illness, we are working on policy, economics, professional development, public education, community demonstrations, and other fronts to learn what works and to forge the commitment to change. Ours is a multiyear project sponsored by Altarum Institute, a nonprofit research and consulting organization. Working with partners around the country, we are learning more about what works and how change might occur.