Medicare Incentives and Penalties: Critical Lessons Learned

The Facilities for Medicare and Medicaid Companies is requiring hospitals to show increasingly that they aren’t solely decreasing the prices of well being companies however that they’re coordinating care higher for sufferers. Numerous packages have aimed to do that, together with the implementation of computerized affected person information, turning to various fee fashions that reward high quality over fee-for service, and reporting Medicare affected person information on high quality and security measures. 

Those who excel are rewarded, however many hospitals additionally face penalties. Whereas the nationwide readmission charge is dropping, federal information present that in 2014 a file 2,600-plus hospitals have been fined for seeing too many sufferers return for care inside 30 days.

These matters have been mentioned throughout a panel Tuesday within the District of Columbia on the U.S. Information Hospital of Tomorrow convention, titled “Medicare Incentives and Penalties: Important Classes Realized.” Members of the panel included Kim Henrichsen, vice chairman of scientific operations and chief nursing officer for Intermountain Healthcare; Akin Demehin, senior affiliate director of coverage on the American Hospital Affiliation; and Dr. Elizabeth Mort, senior vice chairman of high quality and security, and chief high quality officer at Massachusetts Common Hospital.  

Ellen Lukens, senior vice chairman at Avalere Well being, moderated the dialog. 

  • Panelists mentioned the varied measures hospitals consider, together with hospital-acquired situations, readmissions, and incentive packages for digital well being information. 
  • Hospitals that diminished extra readmissions diminished Medicare funds by 3 %, Demehin stated. Knowledge from the American Hospital Affiliation present hospitals saved $420 million in 2016, and greater than $1.3 billion in penalties since 2013. 
  • Mort shared that Massachusetts Common Hospital’s three overarching targets included main in high quality, bettering affected person security and excelling on exterior surveys and measures. 
  • Henrichsen stated that taking a look at sufferers’ size of keep concerned taking a look at acceptable size for every.
  • Demehin identified, nonetheless, that the system can penalize hospitals who serve a disproportionate variety of the neediest sufferers and people with advanced situations. “A number of the variations in affected person populations are simply not accounted for by the measures,” he stated. “Some hospitals are concentrating on sure teams and doing what they need to, however are nonetheless seeing readmissions charges enhance.” 
  • Mort confirmed information that requiring hospitals to place their high quality measures on-line for the general public to see elevated accountability and resulted in enhancements. 
  • Mort additionally stated the hospital was targeted on administrative burden and burnout, as the brand new necessities can pile on extra work for hospital workers. 
  • A part of delivering higher care means getting sufferers engaged of their well-being. Henrichsen reported that Intermountain Healthcare had modified its mission from strictly delivering excellence in well being care to “serving to folks stay the healthiest lives doable.”

The session confirmed the vary of cuts and bonuses from the Facilities for Medicare and Medicaid Companies, demonstrating each how rules assist enhance care but additionally the place rules themselves might enhance. Panelists agreed that extra information are wanted on the Medicare inhabitants, or child boomers, which is able to proceed to develop as extra folks age into the system.  

“We do not have good measures for that inhabitants,” Mort stated. “The measures are inclined to concentrate on the particular illness moderately than the affected person inhabitants.”

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