AHRQ eyes role for primary care in reducing hospital readmissions
- The federal Agency for Healthcare Research and Quality is exploring ways to cut down on unnecessary hospital readmissions by via better use of post-discharge primary care visits.
- According to a notice in Monday’s Federal Register, the agency is requesting approval of a 30-month project to identify specific aspects of primary care that could be improved to reduce readmissions.
- The goal of the project — which requires Office of Management and Budget approval — is to reengineer primary care visits to allow for an effective intervention that can be tested in various primary care settings.
There were about 3.3 million hospital readmissions in 2011, according to AHRQ. Medicare beneficiaries have the highest readmission rate (17.2 per 100 admissions), followed by adult Medicaid beneficiaries (14.6 per 100 admissions) and privately insured adults (8.7 pre 100 admissions). Combined, they add $41.3 billion to U.S. hospitals costs each year.
Reducing early readmissions is a priority for hospitals. Under the Medicare Hospital Readmissions Reduction Program, the Centers for Medicare & Medicaid Services reduces a hospital’s Medicare payments if it has an excessive number of readmissions within 30 days. While at least one study shows CMS' readmission penalties made an impact, many health policy analysts are skeptical that 30 days is an accurate quality marker for readmission rates.
A recent study in the journal Surgery, for example, found patient factors play a big role in determining who will be admitted, particularly if the patient is a minority or poor.
While hospitals and insurers have worked to bring down readmission rates in recent years, those efforts have focused on improving care delivery within the hospital setting, rather than on primary care, AHRQ says.
AHRQ plans to collect data at nine primary care sites and develop evidence-based guidance for the primary care setting to reduce readmissions and enhance patient safety. Public health consultants will be engaged to study the organizational and patient characteristics of each site and map workflow processes. The project will also include patient interviews to capture their perspectives on where the transition from hospital to home may be breaking down.
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