California Health: Readmission Penalties Prompt Hospitals to Improve Follow-Up Care

By Chris Richard

For every five Medicare beneficiaries discharged from a U.S. hospital, one person returns for within a month.

Often, doctors and federal policymakers say, those people could have avoided that second trip to the hospital altogether if only they’d received good follow-up care.

Now, pressured by federal penalties for high readmissions, some California hospitals are revamping discharge procedures and assigning health coaches to monitor patients for up to a month after they’re disconnected from the hospitals’ high-tech monitors.

Training for recently discharged patients ranges from roll-play practice in calling a doctor to tutorials in fundamental skills such as how to keep track of medication schedules and prescriptions.

The change follows on a Medicare policy instituted as part of national healthcare reform.

Since last fall, Medicare has been reducing its payments to hospitals under a provision in the Affordable Care Act that seeks to improve the quality of care. For each hospital, federal authorities calculate an expected readmission rate, based on that facility’s mix of patients. Hospitals that exceed their expected rate can lose up to 1 percent of their regular Medicare payments. The maximum punishment will rise to 2 percent with the start of a new federal fiscal year in October and to 3 percent in the autumn of 2014.

Such a penalty can cost a hospital millions of dollars.

“I believe that Medicare made a good decision with this policy,” said Robert Wachter, a professor at the UC San Francisco Department of Medicine and an authority on health care quality.

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