CMS and providers have reason to celebrate

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Elizabeth Newman
Elizabeth Newman

By the end of September, it's possible the Centers for Medicare & Medicaid Services will drop its final rule for nursing homes, and on Oct. 1 providers will have to tackle MDS RAI  updates. By Nov. 14, providers have to turn in their first official payroll-based journal report.

So before all that, I'd encourage providers to pause and pat themselves on the back.

That's because 30-day hospital readmission rates have dropped in all states except one over the past five years, according to data released this week from the Centers for Medicare & Medicaid Services.

Since 2010, HHS estimates Medicare beneficiaries have avoided 565,000 readmissions.

CMS Chief Medical Officer and Principal Deputy Administrator Patrick Conway, M.D., gave credit to the Hospital Readmissions Reduction Program and other federal initiatives. I agree one of the Affordable Care Act's under-discussed successes involves reduction in hospital readmission. Even if you dislike the ACA, I think that Conway, you and I would agree long-term care providers should share in credit for an 8% decrease in national readmission rates.

Specifically, I am thinking about individual acts of competence and kindness. Whether it's an administrator, director of nursing or medical director at a long-term care facility, each reader should be able to think of at least one case in the past five years where a resident didn't bounce back to the hospital. That may be a case where a provider talked to the family about the beneficiary's wish to die at home, or a case where a urinary tract infection was either prevented or treated at the facility. It could be a case where a nursing home's agreement with a home health group meant a nurse followed up with a discharged resident and discovered a problem with taking medication correctly, or where a short-term rehab patient with comorbidities received better quality care than he would have a decade ago.

Five years ago, it was not a secret that many long-term care providers often had late-night conversations with physicians that ended with, “Send her to the ER.” The old system didn't incentivize taking time to do the right thing, such as keeping a senior citizen with dementia from returning to the hospital.  

Readmission rates are not without controversy as related to whether they correlate to quality of care, and we should remember that data doesn't always tell the full story. The one state that had a virtually unchanged readmission rate was Vermont. What is going on in the Granite State, you might ask? Well, its readmission rate was 15.3% in 2010 and 15.4% in 2015. It had only roughly 15,400 hospital admissions to begin with, and last year about just 16,300. There were 21 more readmissions in 2015, which I wouldn't be losing sleep over if I worked or lived in Vermont.

Also worth noting is many bigger states, such as California, Florida, New York, Illinois and Ohio, had significantly fewer hospital admissions in 2015. Is that a function of better care that keeps people out of the hospital to begin with? Or abuse of “observation stay” rules that keep people from being admitted?

We should always question whether data paints the full picture, and ask how we can do better. But in an era where providers believe it's harder and harder to do a good job, there's evidence here that many Medicare beneficiaries are having better experiences because the system has changed.

Follow Elizabeth Newman @TigerELN.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.