The Centers for Medicare and Medicaid Services (CMS) currently penalizes hospitals if their patients are readmitted after a hospitalization, in an effort to reduce hospital costs for the nation’s seniors and at-risk, writes D Magazine. CMS incentivizes hospitals to get patients out of the hospitals and to recover at home. Readmissions negatively affect hospital ratings.
Researchers at UT Southwestern reviewed how these hospitals are rated and published a study that supports a new way to evaluate hospitals. While patients may leave the hospital, they often end up in skilled nursing, rehabilitation, or other long term care facilities. This means that they still require costly care, but the hospital is not punished unless they return to the hospital. In 2019, CMS penalized nearly 2,600 U.S. hospitals and withheld an estimated $563 million in Medicare payments because the hospitals exceeded the expected number of patient readmissions.
That means a hospital whose patients are out of surgery and recovering quickly at home are evaluated in a similar way to a hospital whose patients spend months in a rehab facility or with nursing aides, adding costs to Medicare. The researchers at UT Southwestern developed a new way to evaluate hospitals that consider full recovery, proposing that Medicare look at the number of days a patient spends at home after discharge to ensure that hospitals aren’t pushing patients out the door who may need significant nursing care, or have died. The proposed metric measures how many of the 30 days following hospitalization are spent at home, or as they call it, the “risk-adjusted 30-day home time” test, as opposed to the current 30-day measure that only measures if a patient returns to the hospital.
The study says that the new metric complements the original 30-day readmission metric “by not only accounting for post-discharge mortality but also the variability in the post-acute care utilization of intermediate/long-term care facility and [skilled nursing facilities]. A home time metric may be more easily understood by patients and clinicians.”
- D Magazine: Modest Proposal: A New Report Card for Rating Hospitals
- Evaluation of Risk-Adjusted Home Time After Hospitalization for Heart Failure as a Potential Hospital Performance Metric. JAMA Cardiology. October 28 2020