Leveraging Technology to Reduce Hospitals’ Growing Financial Risk

Posted by Mary Kay Thalken, RN, MBA on 3/31/16 9:27 AM

The reality of reform is harsh. In 2015, 2,592 hospitals were penalized to the tune of $420 million dollars for patient readmissions.

To attack the readmission challenges that hospitals face, you must first understand and solve the discharge challenges. The point at which the patient transitions from the hospital to the next level of care is a mission critical point.

The recently proposed Centers for Medicare & Medicaid Services (CMS) discharge planning regulations present an opportunity for hospitals and other health-care providers to improve the discharge process. With the proposed regulations, hospitals are faced with the need to:

  • Provide better communication and coordination with disparate providers and facilities
  • Accurately determine the level of readmission risk of a patient as well as specific areas of concern
  • Move patients as quickly as clinically appropriate to a lower level of care
  • Provide both clinical and non-clinical services to keep the patient well
  • Maintain communication and patient status at the patient’s care facility, home or other service location
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Topics: Care Transitions, Medicare Readmission Penalties, Healthcare Technology Solutions

3 Ways Hospitals Can Navigate “Act One” of CJR Payment Rule

Posted by Mike Cassling, Chairman and CEO of CQuence Health Group on 3/21/16 11:25 AM

The stage is set and the curtain goes up April 1. That’s when the Centers for Medicare & Medicaid Services’ (CMS) new Comprehensive Care for Joint Replacement (CJR) value-based payment rule will take effect.

This marks the first time CMS has required participation in a value-based program. In the CJR model, hospitals are financially responsible for the quality and cost of an “episode of care” for hip and knee replacements, from admission all the way through 90 days post-discharge. The episode includes all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries. Honestly, hips and knees are likely just the beginning. Consider this “Act One” of bundled payments for common inpatient surgeries.

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Topics: Healthcare Reform, Care Transitions, Medicare Readmission Penalties

Revisions to CMS Rule for Discharge Planning Proposed

Posted by Luis Castillo on 11/10/15 12:33 PM

Last week, The Centers for Medicare and Medicaid Services (CMS) issued a proposed revision to the rule surrounding the discharge process for hospitals, rehab facilities and home health agencies.

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Topics: Medicare Readmission Penalties, Value-based payment models

Reducing All-Cause, Unplanned Readmissions with Improved Risk Stratification

Posted by Jill Reeves, MHA on 2/2/15 3:39 PM

Some readmissions are unavoidable and result from the inevitable progression of diseases or chronic conditions; however, the Medicare Payment Advisory Commission (MedPAC) has estimated that nearly 76 percent of readmissions are potentially preventable, and may result from poor quality of care or inadequate transitional care.

Risk stratification

One of the programs that works to reduce unnecessary readmissions to improve care quality and reduce per capita costs is the Centers for Medicare & Medicaid Services’ (CMS) Readmission Reduction Program, which penalizes hospitals who are incurring an excessive amount of 30-day readmissions. 

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Topics: Medicare Readmission Penalties, Risk Stratification, Reducing Readmissions

Using Your Post-Acute Network to Reduce Readmission Penalties: An ANI Sneak Preview

Posted by Wayne Sensor on 6/12/14 9:22 AM

Last year, two-thirds of eligible hospitals felt the blow of readmission penalties, which totaled $227 million, according to the Healthcare Financial Management Association. Since CMS announced it would enforce these regulations, hospitals have been searching for effective strategies to address the complicated factors involved with readmissions.

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Topics: Post-acute Care, Care Coordination, Healthcare Reform, Medicare Readmission Penalties, Ensocare News