Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

CMS Awards $110M in ACA Funds to Cut Avoidable Readmissions

By Jacqueline DiChiara

- The Centers for Medicare & Medicaid Services (CMS) has awarded $110 million to 17 national, regional, and state hospital associations and health system organizations to help slash preventable hospital readmissions.

Partnership for Patients Hospital Engagement Networks hospital readmissions

CMS’ Partnership for Patients initiative, which originated four years ago, is a nationwide public-private partnership intended to slash preventable hospital-acquired conditions by 40 percent and 30-day readmissions by 20 percent through a second round of the Hospital Engagement Networks (HENs), says CMS. The goal of such is to strengthen the overall quality of patient care within a hospital setting, CMS adds.

Says Patrick Conway, MD, CMS Acting Principal Deputy Administrator and Chief Medical Officer, “We have made significant progress in keeping patients safe and we are focused on accelerating improvement efforts through collaboration and reliable implementation of best practices.” Such efforts will allow CMS to help advance health safety, Conway adds.

Readmissions are a billion dollar issue

Preventable readmissions are extremely expensive, costing Medicare an estimated $26 billion annually in “avoidable” and “unnecessary” medical spending, as RevCycleIntelligence.com reported. Last year, Medicare fined over 2,500 hospitals for admitting patients within 30 days of discharge – a record high.

The reported national readmission rate has dropped annually since 2012 with a steady 19 percent rate maintained from 2007 to 2011, additionally wrote RevCycleIntelligence.com. In 2013, this national readmission rate allegedly dropped to nearly 17 percent.

CMS’ effort is one of many across the industry

CMS says since implementation of the Partnership for Patients, the “vast majority” of hospitals and stakeholders are on board with its efforts. “50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013,” explains CMS, in reference to research from the Department of Health and Human Services (HHS).

CMS confirms patient safety is much more advanced in comparison with recent years. More than 1 million negative infections and the like have been successfully circumvented, says CMS, resulting in a 17 percent decline in hospital-acquired conditions within a three-year time frame. “Initiatives like the Partnership for Patients, Accountable Care Organizations, Quality Improvement Organizations, and others have helped reduce hospital readmissions in Medicare by nearly 8 percent between January 2012 and December 2013 – translating into 150,000 fewer readmissions – in addition to the quality improvements mentioned above,” CMS adds.

17 organizations to receive contracts named by CMS

CMS confirms the 17 organizations to work with over 3,700 hospitals with contracts received in round two of HEN are: American Hospital Association (AHA), Ascension Health, Carolinas HealthCare System, Dignity Health, Healthcare Association of New York State, Health Research Education Trust of New Jersey, Hospital & Healthsystem Association of Pennsylvania (HAP), Iowa Healthcare Collaborative, LifePoint Health, Michigan Health & Hospital Association Health Foundation, Minnesota Hospital Association, Ohio Children’s Hospital Solutions for Patient Safety, Ohio Hospital Association, Premier, Inc, Tennessee Hospital Association, VHA-UHC Alliance NewCo Inc, and Washington State Hospital Association.

HEN’s overarching objectives are as follows, says CMS:

  • Develop learning collaboratives for hospitals;
  • Provide a wide array of initiatives & activities to improve patient safety;
  • Conduct intensive training programs to help hospitals make patient care safer;
  • Provide technical assistance to help hospitals achieve quality measurement goals;
  • Establish & implement a system to track & monitor hospital progress in meeting quality improvement goals.
  • Identify high performing hospitals and their leaders to coach and serve as national faculty to other hospitals committed to achieving the Partnership goals.

“The Affordable Care Act takes important steps toward a more accessible, affordable, and higher-quality health care system. Today’s announcement is part of a broader effort to transform our health care system into one that works better for the American people," concludes CMS regarding its overarching goals. "The Administration has a vision of a system that delivers better care, spends our dollars in a smarter way, and puts patients in the center of their care to keep them healthy.”

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