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Measuring Readmissions For Improvement, Accountability, And Patients


September 6th, 2013

Kaiser Health News recently published a list of 2,225 hospitals that will be penalized through the second year of the federal government’s Hospital Readmissions Reduction Program (HRRP). The list indicated the percentage that the hospitals’ base Medicare reimbursements will be reduced (0.38% on average) due to “excess” readmissions when the next round of penalties takes effect on October 1, 2013.

News of the release brought with it a renewed focus on the program and the efficacy of its approach, which is designed to counter perverse fee-for-service incentives in which hospitals are financially rewarded for readmitted patients. A chorus of concerns related to the methodology used to calculate “excess” readmissions has been raised by hospitals and researchers since the program was mandated by the Affordable Care Act.

Transitioning the health system toward value. Beyond methodological concerns, there is a question of the long-term policy role the HRRP should play as Medicare and other payers promote broader payment and delivery system reforms such as value-based purchasing, bundled payments, accountable care, and medical homes. These reforms may offer more positive and stronger incentives for improvement across the care continuum than the HRRP penalties. However, it is too soon to judge the effectiveness of these reforms, nor is it clear how quickly and widely they will be adopted.

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“Out Of The Blocks”: Meeting The Challenge Of Transforming Health Care


December 11th, 2012

No other presidential election in American history has been freighted with such significance for health care as was last month’s vote. Uncertainty over the future of health policy dominated the discourse, and we all waited with bated breath for clarity from the voters.

Thirty-six days ago, we got just that. In one night, much of the uncertainty that had marked the past few years faded into history.

But now we all face a different and urgent kind of uncertainty — a pressing question: How, with this newfound certainty in the policy environment, can health care stakeholders best move forward on problems of high costs and suboptimal quality, of poor coordination and preventable medical error, soon enough to meet the social need?

Time is running out to find answers. Health care costs, much of them waste, continue to climb, and too many patients are not getting the high-quality care they need. If we do not act — and act quickly — to transform health care, we will face blunt cost cutting and declining access and quality, particularly for the poorest among us.

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