What’s the Best Way to Get Hospitals Involved in Care Coordination?

Pay them to do it, take money away when they don’t — make hospitals accountable for their role in avoiding unnecessary readmissions.

Mark E. Miller, Ph.D., Executive Director, Medicare Payment Advisory Commission testified recently in front of the U.S. Senate Committee on Finance. He opened his remarks by stating:

The health care delivery system we see today is not a true system: care coordination is rare, specialist care is favored over primary care, quality of care is often poor, and costs are high and increasing at an unsustainable rate.

About a quarter of Mr. Miller’s testimony focused on an issue that hasn’t received much attention: avoidable hospital readmissions . Here are some key excerpts:

Spending on readmissions is considerable. We have found that Medicare spends $15 billion on all-cause readmissions and $12 billion if we exclude certain readmissions…. To target policy avoidable readmissions, Medicare could compare hospitals rates of potentially preventable readmissions and penalize those with high rates.

Penalizing high rates of readmissions encourages providers to do the kinds of things that lead to good care, but are not reliably done now. For example, the kinds of strategies that appear to reduce avoidable readmissions include preventing adverse events during the admission, reviewing each patient’s medications at discharge for appropriateness, and communicating more clearly with beneficiaries about their self-care at discharge. In addition, hospitals, working with physicians can better communicate with providers caring for patients after discharge and help facilitate patient’s follow-up care.

Information alone will not likely inspire the degree of change needed.

We have two recommendations — one to change payment for readmissions and one to bundle payments across a hospitalization episode….A change in readmissions payment policy could be a critical step in creating an environment of joint accountability among providers that would, in turn, enable more providers to be ready for bundled payment.

What might happen if hospitals were paid to coordinate care after a discharge and/or not paid when a rehospitalization could have been avoided? The change would be profound:

• Hospitals would start investing in remote monitoring equipment and systems
• Hospitals would need to work more closely with community physicians to coordinate post-hospital care
• Hospitals would need to exchange information with patients at home and with physicians in their offices. This would tremendously advance the cause of increasing data interoperability and liquidity. In turn, hospitals would pressure their IT vendors to make IT systems interoperable.
• Hospitals would look for new ways to leverage investments made in remote monitoring and interoperable IT. The fixed costs of these investments could be spread across many new disease/care management programs.  Innovative initiatives like Hospital at Home could flourish.

Nice to think about.

Dr. Miller, you’re definitely on the right trail.