Worried about Medicare readmission penalties? Try home monitoring

By Neil Versel
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Neil_Versel_LargePerhaps you've seen last month's report from Kaiser Health News that more than 2,200 hospitals—almost two-thirds of all U.S. acute care facilities—face Medicare payment deductions starting Oct. 1 because too many patients with three common but treatable conditions were readmitted within 30 days of initial discharge. That's going to cost those hospitals a total of $280 million during federal fiscal year 2013.

A lot of institutions with high numbers of low-income patients will lose out, but these include some of the supposedly "best" hospitals in America. Barnes-Jewish Hospital in St. Louis – a source of pride in my world because it's affiliated with my alma mater, Washington University – will suffer the maximum penalty, a 1 percent cut in base Medicare reimbursements. Massachusetts General Hospital, named the top hospital in America by U.S. News & World Report, faces a 0.5 percent reduction, Kaiser Health News reports.

In other words, hospitals no longer can skate by on their reputations. The financial onus now is on them to prevent inpatient complications and provide proper follow-up care for patients admitted for heart attacks, heart failure and pneumonia. (That's the kind of real reform in the Patient Protection and Affordable Care Act that "Obamacare" supporters and detractors alike somehow don't want to talk about this election year and that the national media is giving them a pass on.)

By the way, the maximum penalty increases to 2 percent in fiscal 2014 and 3 percent the year after that. The message from the federal government: we won't pay for sloppiness anymore.

I think hospitals truly are working at getting their readmission rates down, but many seem to be doing it the hard way. The University of Mississippi Medical Center, which escaped financial penalties during the initial measurement period, July 2008 to June 2011, has reduced readmissions for heart failure by having doctors call patients at home following discharge. "It's a fairly simple approach, but it's very labor-intensive," Chief Quality Officer Michael Baumann told KHN.

It doesn't have to be. As readers of MobiHealthNews certainly know, the phone can be highly inefficient, especially if you get voice mail – and it may not even be OK under HIPAA to discuss specific patient cases in a voice mail, particularly if you can't be certain that only the patient in question will hear the message.

Remote, home-based monitoring, on the other hand, requires little or no work on the doctor's part. It's a reasonably small investment compared to the money hospitals stand to lose by not getting readmission rates down. And the data remote monitoring systems collect certainly are more accurate and detailed than what a patient might report over the phone.

Unfortunately, hospitals still take a 20th Century attitude toward 21st Century problems. And we're largely stuck with an outdated healthcare "system" – I use that term loosely – where many would rather make excuses and fight hard to preserve the status quo than to adopt new ways that can keep patients healthier and, as a bonus, save providers money.