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Boston Globe Op-Ed: How Rehospitalizations are Hurting Medicare |
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From The Commonwealth Fund: One of the biggest health care challenges facing Congress is avoiding cutting Medicare's physician fees while controlling costs for the program. In an op-ed published today in the Boston Globe, Commonwealth Fund board member Robert Pozen and Commonwealth Fund senior vice president Cathy Schoen suggest a practical way to save Medicare billions of dollars--by preventing avoidable hospital readmissions. GETTING Medicare costs under control is no easy job. Congress recently overrode a scheduled 11 percent cut in Medicare's physician fees by freezing them for the rest of 2008 with a slight raise in 2009. But the program's finances will continue to worsen as baby boomers retire. Avoiding deep cuts in physician fees from 2010 onward will require a $20 billion fix every year for the following decade. But there is a straightforward way to pay for half of this fix. Medicare spends vast sums on hospital care for patients readmitted within 30 days of their previous stay in a hospital. And if Congress focuses on reducing the need for rehospitalization in areas where the practice is most common, Medicare could save many billions of dollars. The percentage of Medicare patients readmitted to the hospital within 30 days averaged 18 percent in 2005 - based on an analysis by the Commonwealth Fund of 30 prevalent medical conditions. But the readmission rate varies from area to area. According to a Medicare Payment Advisory Commission study, 75 percent of all 30-day hospital readmissions in Medicare in 2005 were potentially preventable - or 13 percent of total admissions. To realize these savings, Congress should focus on three objectives: decreasing complications during hospital stays, improving patient communications in the discharge process, and monitoring patients after discharge. Higher rates of hospital readmissions are associated with infections and other complications acquired by patients during hospital stays. Under traditional procedures, Medicare can pay a higher rate for hospital stays involving complications, or can pay for readmissions due to complications or medical errors. In a pilot project in which hospitals were paid bonuses and held accountable for better outcomes, quality improved and readmission rates fell substantially. Some hospitals have had success providing patients at discharge with a "transition coach" to review their medication needs, supply a copy of their health records, and encourage timely follow-ups. Congress should require hospitals to publicly disclose their readmission rates. Furthermore, any hospital above the national average for readmissions should receive a lower rate from Medicare for the second hospital stay.
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