Dive Brief:
- The Centers for Medicare and Medicaid Services (CMS) has pointed toward decreased hospital readmissions among Medicare patients as evidence of increased patient safety and care.
- At the same time, hospitals have sharply increased the number of patients held under "observation status," in which returning patients are treated in the ED or a regular inpatient unit, but billed for outpatient services rather than being designated as a readmission.
- The change amounts to re-labeling and gaming of the system, argues a recent Health Affairs blog, in order to help hospitals meet CMS’ quality standards and avoid penalties for having too many readmissions.
Dive Insight:
The blog suggests there has been little real improvment in quality, and highlights the financial impact in which "billions of Medicare payment dollars are at stake." Outpatient care leaves patients responsible for more of their bill and renders them ineligible for Medicare-paid rehab or skilled nursing care, note authors David Himmelstein and Steffie Woolhandler.
They say that between 2006 and 2013, observation stays increased by 96%, accounting for more than half of the apparent decrease in total Medicare admissions during that time.
Unfortunately, hospitals are currently rewarded equally, whether they reduce readmssions through true improvement and continuity of care or through re-labeling.
The authors suggest that unproven pay-for-performance initiatives pressure hospitals to cheat and corrupt data vital for quality improvement.
