The Editor's desk: CMS takes acute interest in avoiding hospital stays

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James M. Berklan, McKnight's Editor
James M. Berklan, McKnight's Editor
The Hebrew Rehabilitation Center in Boston ought to be getting a lot more attention from the profession. The center has successfully implemented a program that reduces rehospitalization rates.

Hebrew Rehabilitation found success by combining standardized admission templates, palliative care consultations and root-cause analysis conferences. Its patient rehospitalization rate dropped from 16.5% to 13.3%, and discharges home rose to 73%, up from 68.6%. (More details can be found in the June issue of the Journal of the American Geriatrics Society.)

This is vital because the federal government is getting a bit testier about paying for rehospitalizations, particularly when it feels they are avoidable. Shelling out more than an estimated $17 billion for soaring rehospitalization rates (within 30 days of discharge) will do that. Under the Affordable Care Act, Medicare will end payments to hospitals for preventable readmissions for conditions such as heart failure and pneumonia, starting in October 2012. It also has payments for certain vascular procedures in its crosshairs.

So what does this mean for long-term care operators and other rehab providers? Not much — if you don't think increased pressure to get it right the first time (or clean up after other providers' inadequacies) isn't much, that is.

Hospitals are going to be feeling the heat, so by simple laws of conduction, that means you also will be headed for warmer times. Friction will do that. Communication concerning hospital-nursing facility transitions traditionally has not been great, and that relationship is going to be tested more than ever.

You're going to have to keep a closer eye on the condition of residents/patients you receive while also better documenting your charges' condition on the way out. What is often a touchy issue with hand-offs between acute care and sub-acute care providers needs to be examined even more closely. And, of course, it would be optimal to provide efficient care in the meantime.

To ensure you have enough time to do that, providers must continue pushing back against any kind of efforts to retrench on Medicare or other rehab reimbursement rates.

Doing more with less might be an easy line for a bureaucrat, but it doesn't do much for the frontline caregiver trying to keep her ever-older, sicker clients off the “do-over” list back at the hospital.

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