Why are 30 day readmissions not going down?
In this article published by the Kaiser Health News recent Medicare analysis shows 30 day readmissions are not going down and in some cases gone up. There are definite reasons which we explore below.
Hospitals and doctors still get paid based on the sickness care model. It should be no surprise why 30 day readmission rates for common clinical conditions haven't changed over a three year period: Hospitals get paid to readmit patients not to keep them out of the hospital. Even though penalties are about to be applied by Medicare for readmissions the penalties do not outweigh the benefit for hospitals.
It's very difficult to get the entire team required to reduce readmissions to work together. In some cases, the hospital has no control over the outpatient side of the business leading to little connectivity of the clinicians critical to move the readmission metric. Add to that negative financial consequences of reducing readmissions and nothing changes.
At Thedacare 30 day readmission rates for the common conditions identifed in Kaiser Health News have dropped to U.S. benchmark performance of around 8% and guess what's happened? Commercial insurers and Medicare have reaped benefits while Thedacare suffers the financial result of fewer patients in hospital beds. Thedacare is participating in the Pioneer ACO model. Clearly, Medicare needs to pay differently and the Pioneer may be the way to do it. But the payment change is not coming fast enough. Thedacare and others such as Harvard Vanguard Medical Associates in the greater Boston area have proven readmission rates can be dramatically reduced. The problem is they are jeopardizing financial results to do the right thing.
We need more significant payment experiments such as what is happening at the Partnership for Healthcare Payment Reform http://www.phprwi.com/ and the Pioneer ACO model for the industry to truly reform. Grant funding from government and private foundations should be funneled in this direction as quickly as possible if we are going to get on top of the cost and quality crisis.
John S. Toussaint, MD
President and CEO, ThedaCare Center for Healthcare Value