Lung disease experts say that new policies concerning hospital readmissions for chronic obstructive pulmonary disease will penalize vulnerable patients.
Last week, the federal government announced fines for more than 2,600 hospitals because too many Medicare patients being treated for certain conditions are being readmitted within 30 days of being sent home.
An analysis by University of Michigan (U-M) lung disease experts, published in the American Journal of Respiratory and Critical Care Medicine, describes how hospitals that care for poor and minority patients will feel these penalties more deeply.
The Centers for Medicare & Medicaid Services (CMS) consider the current rehospitalization rate of Medicare patients “excessive,” with 1 in 5 being rehospitalized within 30 days of being discharged.
As part of their Hospital Readmission Reduction Program, CMS have, since 2012, reduced payments to hospitals that exhibit excessive readmission rates for heart failure, heart attack or pneumonia patients. The government have now added elective hip and knee replacement readmissions and chronic lung disease readmissions to these penalties.
Dr. Michael Sjoding, a pulmonary and critical care fellow in the U-M Medical School’s Department of Internal Medicine, says that experts worry this policy may be causing more harm than good.
“Medicare is trying to improve patient care and reduce waste,” he says, “but the hospitals they are penalizing may be the ones who need the most help to do so.”
Dr. Sjoding and colleagues evaluated data from 3,018 hospitals looking at a period of chronic obstructive pulmonary disease (COPD) care covering 3 years.
The team believes that teaching hospitals and “safety-net hospitals” will bear the brunt of the financial penalties, as these hospitals care for a larger number of poor or “medically complex” patients with COPD.
These poor or medically complex patients are at a higher risk for readmissions, the experts say, because of an assortment of socioeconomic and health factors.
Although the Hospital Readmission Reduction Program is intended to provide incentives for hospitals to reduce readmissions – and therefore improve the quality of their care – research has shown that patients are often readmitted for reasons beyond the control of hospitals.
Dr. Sjoding explains:
“If patients can’t afford medications, or have unstable housing situation, they may end up being readmitted to the hospital. No interventions to date have effectively and sustainably reduced COPD readmissions, so it’s unclear what a hospital can do to prevent them.”
The researchers say that their findings support previous studies that have found the penalties target hospitals caring for vulnerable patients and suggest the policy should be changed.
Last week, Harvard Medical School Department of Health Care Policy published an analysis of a key Medicare reform in the New England Journal of Medicine.
The Harvard team investigated an Affordable Care Act reform, whereby a new payment model – Accountable Care Organizations (ACOs) – allows provider groups to share savings when they reduce Medicare patient spending and improve quality of care. About 11% of Medicare beneficiaries are now served by ACOs – a total of 5.6 million patients.
The researchers found that the reform had resulted in improvements to the system, particularly among the most medically complex quarter of patients with multiple illnesses. Beneficiaries reported improved access to care and to medical information, as well as perceived improvements to coordination of their care.