BY VIRGIL DICKSON | JUNE
18, 2018
The CMS' Hospital Readmissions Reduction Program is not increasing
the number of observation stays, according to a new analysis of the program.
Although several academic studies have found that the readmission
program wasn't lowering Medicare spending and led to more observation stays,
the Medicare Payment Advisory Commission (MedPAC) said there is no evidence
that trend exists.
Readmissions rates from 2010 to 2016 for heart attacks, heart
failures and pneumonia all dropped between 1.4% to 3.6% saving Medicare $2 billion
annually, according to MedPAC's analysis sent to Congress Friday.
Over that same period, the commission found only a small uptick in
observation stays and noted that the increase did not offset savings from the
readmission program.
Academic researchers claimed that hospitals were keeping patients in an outpatient observation status and not readmitting them to not be penalized under the program.
MedPAC found patients that weren't recently admitted to the hospital experienced a similar increase in observation stays.
"We conclude that the reduction in readmission rates reflects real changes in practice patterns and not simply a shifting of short-stay admissions into observation stays to avoid readmission penalties," MedPAC said in its report.
Jordan Albritton, a senior statistical data analyst at Intermountain Healthcare who has analyzed the readmissions program, questioned the validity of the findings.
MedPAC's analysis relied on observational studies that are prone to bias, Albritton said. His research used an analytical approach similar to a randomized controlled trial.
"We found evidence that the [readmission program] does increase the duration and frequency of observation stays," he said. "The increase is small but significant."
MedPAC's report suggested that Congress should allow rural stand-alone emergency departments that are more than 35 miles from another emergency department to bill at higher outpatient rates.
The commission also called on Congress to cut off-campus, stand-alone emergency departments' reimbursements by 30% if they are within six miles of an on-campus hospital emergency department. That would put those ED's payments more in line with urgent care centers and physician offices, and those providers generaly are not open 24 hours per day like traditional EDs.
The rural proposal gained support from some clinicians
Some hospitals have viewed such standalone EDs as "gravy trains" that generate additional income off wealthier and healthier patients, according to Dr. Michael Brown, chair of the department of emergency medicine at the Michigan State University College of Human Medicine.
Dr. Richard Zane, University of Colorado Hospital's chief innovation officer and professor and chair of Emergency Medicine at the CU School of Medicine slammed MedPAC's recommendations for standalone urban EDs.
"The recommendation is arbitrary and capricious and doesn't seem based on any data," Zane said.
His system opened 19 standalone facilities in the last decade, opening them in areas around that state experiencing population growth.
"We're really addressing the needs of the population," Zane said. "If these recommendations are adopted, it will decrease access to emergency care."
Academic researchers claimed that hospitals were keeping patients in an outpatient observation status and not readmitting them to not be penalized under the program.
MedPAC found patients that weren't recently admitted to the hospital experienced a similar increase in observation stays.
"We conclude that the reduction in readmission rates reflects real changes in practice patterns and not simply a shifting of short-stay admissions into observation stays to avoid readmission penalties," MedPAC said in its report.
Jordan Albritton, a senior statistical data analyst at Intermountain Healthcare who has analyzed the readmissions program, questioned the validity of the findings.
MedPAC's analysis relied on observational studies that are prone to bias, Albritton said. His research used an analytical approach similar to a randomized controlled trial.
"We found evidence that the [readmission program] does increase the duration and frequency of observation stays," he said. "The increase is small but significant."
MedPAC's report suggested that Congress should allow rural stand-alone emergency departments that are more than 35 miles from another emergency department to bill at higher outpatient rates.
The commission also called on Congress to cut off-campus, stand-alone emergency departments' reimbursements by 30% if they are within six miles of an on-campus hospital emergency department. That would put those ED's payments more in line with urgent care centers and physician offices, and those providers generaly are not open 24 hours per day like traditional EDs.
The rural proposal gained support from some clinicians
Some hospitals have viewed such standalone EDs as "gravy trains" that generate additional income off wealthier and healthier patients, according to Dr. Michael Brown, chair of the department of emergency medicine at the Michigan State University College of Human Medicine.
Dr. Richard Zane, University of Colorado Hospital's chief innovation officer and professor and chair of Emergency Medicine at the CU School of Medicine slammed MedPAC's recommendations for standalone urban EDs.
"The recommendation is arbitrary and capricious and doesn't seem based on any data," Zane said.
His system opened 19 standalone facilities in the last decade, opening them in areas around that state experiencing population growth.
"We're really addressing the needs of the population," Zane said. "If these recommendations are adopted, it will decrease access to emergency care."
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