FutureFocus April 25, 2018: Readmission Insight for Post-Acute Providers

Lisa Remington

In this week’s FutureFocus, we provide a recent study related to readmissions and implications for post-acute providers. In another article, we address recommendations being considered for new performance measures for Home Health and Hospice.  This is a must read. There is new legislation to allow hospice to dispose of unused medications in the home after a patient expired. This legislation is supported by NAHC. 

Lisa Remington, President, Remington Health Strategy Group

A recent study published in the journal Health Affairs has implications for post-acute providers serving hospitals in urban areas. The study examines the impact of Medicare’s Hospital Readmissions Reduction Program (HRRP) on reducing racial disparities.

Before the HRRP was initiated under the Affordable Care Act, there was evidence that black patients had, on average, 20 percent higher readmission rates than white patients, the study authors noted.

“In addition, hospitals that served a higher proportion of black patients had higher readmission rates than other hospitals had, even after patient complexity was accounted for.” However, “since HRRP implementation there has been emerging evidence that readmission rates have fallen.”

The authors compared trends in thirty-day readmission rates for selected conditions in a national sample of Medicare beneficiaries: readmissions from 2007 to 2014 across three time periods related to the HRRP, from pre-HHRP to the penalty phase in 2014.

They found that the HRRP was associated with a narrowing of disparities between non-Hispanic white and black patients’ hospital readmissions rate. They observed a similar narrowing in the rates gap between minority-serving and other hospitals. Despite these gains, the authors noted that disparities still persist and minority-serving hospitals continue receiving disproportionately high HRRP penalties.

“Despite the narrowing of the two race-based gaps after announcement of the Hospital Readmissions Reduction Program, both persist. It remains to be seen whether new policy efforts will narrow these gaps and reduce the disproportionately high penalties that minority-serving hospitals face.”

Study title in the online April issue of Health Affairs: “Medicare Program Associated with Narrowing Hospital Readmission Disparities Between Black and White Patients”. It was conducted by José Figueroa, Ashish Jha, and coauthors from the Harvard T. H. Chan School of Public Health.

Meal Delivery Programs Found to Reduce Healthcare Costs

Food insecurity has been associated with poor health and increased use of certain “big-ticket” health services such as emergency department visits and inpatient hospital and nursing home admissions. Seth Berkowitz of the University of North Carolina at Chapel Hill and coauthors sought to determine whether food delivery programs for dually eligible Medicare and Medicaid enrollees could reduce their medical spending (five service categories studied: inpatient, outpatient, emergency department, pharmacy, and emergency transportation).

The authors sampled members of the Boston-based Commonwealth Care Alliance who were part of two delivery programs during the years 2014 and 2015. One program customized the food to meet the medical needs of participants, while the other provided standard nutritious meals.

The authors found that providing these programs yielded sizable reductions in the use of the ED and other high-cost services. They conclude that these findings suggest the potential for meal delivery programs to reduce the use of costly health care and decrease spending for vulnerable patients.

“Compared with matched nonparticipants, participants had fewer emergency department visits in both the medically tailored meal program and the non-tailored food program. Participants in the medically tailored meal program also had fewer inpatient admissions and lower medical spending,” the authors concluded.

“Participation in the non-tailored food program was not associated with fewer inpatient admissions but was associated with lower medical spending. These findings suggest the potential for meal delivery programs to reduce the use of costly health care and decrease spending for vulnerable patients.”

The study also reported in the online April issue of Health Affairs: “Meal Delivery Programs Reduce the Use of Costly Health Care in Dually Eligible Medicare And Medicaid Beneficiaries.”

By: Ronald M. Schwartz, Writer, The Remington Report