Medicare and Pay for Performance

A recent article from Kaiser Health News discussed hospital penalties for readmission rates (http://www.kaiserhealthnews.org/Stories/2013/August/02/readmission-penalties-medicare-hospitals-year-two.aspx).  Healthcare is extremely complex.  It is tragic that Medicare has to use penalties to facilitate hospitals improving the quality of care.  Hospitals who treated poorer patients had larger penalties. 

The first sentence of the article notes "Medicare will levy $227 million in fines against hospitals in every state but one for the second round of the government’s campaign to reduce the number of patients readmitted within a month, according to federal records released Friday."

A few years ago, I was working on an emergency department project.  In the analysis of data, it was evident that too many patients were returning 4-6 times every month.  At that time, hospitals were only concerned about patient returns within 24 hours.

More patient admissions usually means greater amount of revenue potential.  The same thing is true about medical errors and patient falls.  Use of penalties is unfortunate, but it may be the only way to improve care for now. 

Comparing Healthcare

It is interesting to talk with healthcare providers and nursing students (some who are already RNs) regarding hospital comparisons and patient satisfaction.  Several of the RN students thought that the patient satisfaction initiative was only at their facility.  They did not understand that it related to reimbursement.  The Medicare site explaining HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems).
Medicare site - comparing outcomes of HCAHPS (https://www.cms.gov/HospitalQualityInits/30_HospitalHCAHPS.asp) http://www.hospitalcompare.hhs.gov/

Until recently, I did not realize that the AHRQ (Agency for Healthcare Research and Quality) provides the ability for users to view measures of state performance by region (State Snapshots - http://statesnapshots.ahrq.gov/snaps10/index.jsp) for the following:
"•Overall health care quality
•Types of care (preventive, acute, and chronic)
•Settings of care (hospitals, ambulatory care, nursing home, and home health)
•Five clinical conditions (cancer, diabetes, heart disease, maternal and child health, and respiratory diseases)
•Special focus areas on diabetes, asthma, Healthy People 2010, clinical preventive services, disparities, payer, and variation over time"

If you haven't already done so, take a few moments to compare performances of healthcare agencies in your region.

Medicare Website

Medicare has developed a "consumer friendly" website at http://www.medicare.gov/Default.aspx
It includes links to compare hospitals, nursing homes, and way to find a doctor.  Consumers can search for physicians that accept Medicare as full payment. The site is worth exploring.