Providers clash with Medicare over readmission measure

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As summer wanes, tensions are simmering between Medicare and healthcare providers, especially after a new readmission measure was approved by the National Quality Forum (NQF) with allegedly little input from industry professionals.

According to a July 23, 2012, article from Kaiser Health News, this conflict is rooted within the nationwide failure to reduce readmissions rates, even after years of investing in initiatives to confront this problem.

Medicare seems to lay an unequal amount of the blame not on the over 4,000 hospitals in its system, but squarely on the shoulders of eight hospitals, each of whom has been identified and named on its Hospital Compare website.

There is good reason for Medicare to worry about these rates. It spends $17.5 billion each year on readmissions for Medicare beneficiaries. But why charge eight hospitals with the blame?

Part of the problem, the article explains, is found in imprecise statistical calculation. Not every hospital among the 4,000 experiences a large number of readmissions in the three areas Medicare examines—heart attacks, heart failure, and pneumonia. Therefore, it’s difficult to know whether these hospitals should be classified as outliers or not.

Medicare’s new readmission measure, developed with Yale-University researchers, hoped to confront this statistical problem. The goal was to evaluate readmission rates for all conditions that a hospital treats, hopefully producing a more dimensional and accurate performance picture.

When NQF approved the measure, though, providers complained. Eight organizations signed their names to a letter that asserted the NQF listened more to the government than to the providers.

“It is noted that less than 20 percent of the more than 400 NQF members voted on this measure and a disproportionate number of Health Professional and Provider Organization members voted ‘No’, with the final total vote actually being less than 50 percent in favor of the measure,” the providers charged. “These findings call into question serious concerns about whether the NQF Consensus Development Process achieves consensus among affected stakeholders as intended, and reflects decision making in a high stakes environment that is, in our view, neither fair or balanced.”

Among the signers of the letter were such influential providers as Cedars Sinai Medical Center and Johns Hopkins Health Systems.

So far, the NQF is sticking by its decision. In an effort to appease disgruntled providers, it has launched a task force to evaluate its approval process.

This may be a fruitless pursuit, though, since Medicare is about to heighten the severity of its Value-Based Purchasing penalties on underperformers.

-by Pete Fernbaugh

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