Posts tagged ‘heart failure’

Medicare Acute and Post-Acute Care Payments for 30-day Episodes That Began With Hospitalization and Cost Depending on Location

For each of these types of admissions (congestive heart failure), the cost of post-acute care, on average, exceeds that of inpatient care arising from the initial admission and any readmissions. The location in which the patient is discharged is also a factor in the cost.

Continue Reading April 10, 2015 at 4:23 PM Leave a comment

Long-term incentives are needed to reduce healthcare costs

A fascinating study was published in the June 2 issue of the Journal of the American Medical Association and summarized by Maureen McKinney in Modern HealthcareBased on a retrospective study of Medicare data for heart failure patients, the study showed that the average length of stay has decreased 28%, from 8.81 days in 1993 to 6.33 days in 2006.  In-hospital mortality rate decreased 49%, from 8.5% in 1993 to 4.3% in 2006.  Unfortunately, the 30-day hospital readmission rate increased 16.9%, from 17.2% to 20.1%. Also, the percentage of patients discharged to skilled-nursing facilities jumped by more than half, from 13% in 1993 to 19.9% in 2006.

The JAMA article credits the standardized use of acute-care interventions such as beta blockers.  The article notes that the direct correlation between shorter ALOS and readmissions cannot be proven but there is reason to suspect a relationship.

It is challenging enough to reduce short-term healthcare costs.  Many of the clinical advances in the delivery of care that leads to shorter hospital stays, decreased mortality and reduced costs should be appreciated and supported.  Until recently, Medicare reimbursement did not penalize hospitals for the readmission of heart failure patients.  Therefore, there was no incentive to look beyond the immediate benefits of shorter hospital stays.

We all experienced the same issue with Wall Street.  Short term incentives encouraged traders to increase the riskiness of their deals to profit today, reap large bonuses at the end of the year and pay the piper months or years into the future.  If we ever are going to develop a cost-effective, high quality healthcare system, payers need to encourage providers and patients to develop a longer-term perspective.  We need to strike an effective balance between the risk of our clinical pathways and the rewards in terms of improved outcomes and lower costs.  Such balance and advances need to be based on evidence, which takes time to develop.  Therefore, we need our fiscal and non-fiscal incentives (eg, NCQA and JCAHO certifications) to evolve as new evidence comes to light.

June 3, 2010 at 2:40 PM Leave a comment

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