Filed Under:Health Insurance, Medicare

SCAN: Complicated Patients Keep Coming Back

Hospital will bear far more responsibility for departing patients' well-being. (AP Photo/Petros Giannakouris)
Hospital will bear far more responsibility for departing patients' well-being. (AP Photo/Petros Giannakouris)

Starting in October, a provision in the Patient Protection and Affordable Care Act of 2010 (PPACA) will cut Medicare payments for hospitals with high patient rehospitalization rates.

Hospitals may try to get rehospitalization rates down by doing more to manage the care of the most complicated Medicare enrollees: those with 5 or more chronic conditions.

About 38% of Medicare enrollees with 5 or more chronic conditions who left a hospital in 2009 needed more hospital care for some reason within 30 days, according to analysts at the SCAN Foundation, Long Beach, Calif.

For all Medicare enrollees, the 30-day rehospitalization rate was just 16%, the analysts say.

The 90-day Medicare rehospitalization rate was 52% for enrollees with 5 or more chronic conditions and 23% for all enrollees.

The analysts have based those figures on Medicare claims data compiled by Avalere Health L.L.C., Washington.

PPACA also has provided $500 million in funding that hospitals can use to reduce the likelihood that high-risk Medicare enrollees will return to the hospital. The Centers for Medicare and Medicaid Services is setting up Community-Based Care Transitions Program test programs in seven states.

The hospitals participating in the test programs are hoping they can prevent rehospitalizations by reducing medication errors, helping patients communicate better with care providers, and improving their own efforts to communicate with patients and patients' other care providers, the SCAN analysts say.

The stakes are high because, for the traditional Medicare program alone, unplanned rehospitalizations cost about $17 billion in 2004, researchers report in a paper published in the New England Journal of Medicine in 2009.

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