Quality demo cuts repeat hospital Medicare trips by nearly 6%

Washington A Medicare test project that emphasized care coordination to keep patients from going back to the hospital scored lower readmission rates compared with similar regions without such a program in place.

A study on the Medicare quality improvement organization pilot in the Jan. 23/30 Journal of the American Medical Association reported that 30-day readmission rates in 14 communities were reduced by 5.7% over two years beginning in 2008. In an average locale serving 50,000 Medicare beneficiaries, the care coordination model would cost $1 million a year but also save $4 million by preventing return trips to hospitals, said lead author Jane Brock, MD, MSPH.

“When you have a bunch of providers trying to function in concert on behalf of the population they already mutually serve, we think that’s the key intervention that explains our success,” said Dr. Brock, who is chief medical officer for the Colorado Foundation for Medical Care.

Following the success during the trial period, the Centers for Medicare & Medicaid Services has moved to expand these improvement groups nationwide by 2014. Researchers believe the program could save the system billions of dollars nationally.

The quality improvement organizations trace and track patients as they move through the health system. Individuals called conveners are hired to help patients obtain appropriate follow-up care after illnesses, such as heart failure. Case managers help patients keep personal care records, noting prescribed medications and appointments with physicians, to manage chronic conditions.

Most conveners in the demo worked with primary care physicians, who often are charged with medical responsibility of a patient at discharge, Dr. Brock said. The quality organizations would ensure notification of discharge by establishing physician work groups to discuss the method by which doctors preferred to be told about their patients. For instance, some physicians preferred messages to be left with their office managers, while others wanted emails.

The project involved physicians, facilities and health professionals in Tuscaloosa, Ala.; Denver; Miami; Atlanta; Evansville, Ind.; Baton Rouge, La.; Lansing, Mich.; Omaha, Neb.; Camden, N.J.; Albany, N.Y.; Pittsburgh; Providence, R.I.; Harlingen, Texas; and Whatcom County, Wash.

The JAMA study compared performance in these communities with rehospitalization rates in 50 similar regions — where readmissions also declined, but by just 2.05% (link).

CMS Chief Medical Officer Patrick Conway, MD, congratulated the groups for working together to decrease hospitalizations. Dr. Conway also is director of the CMS Center for Clinical Standards and Quality.

“We hope this continues its amazing success in terms of keeping beneficiaries healthier and that we continue to learn as we do this work and improve,” he said.

The Obama administration has established a goal of reducing avoidable readmissions by 20%. Officials are aiming to achieve it through myriad policy and program changes.

One such reform involves Medicare payment for care coordination activities that began in January. The American Medical Association Current Procedural Terminology Editorial Panel created new CPT codes (99495 and 99496) for billing care coordination, which CMS adopted in its 2013 Medicare physician fee schedule. The codes are billed for time spent “discussing a care plan, connecting patients to community services, transitioning them from inpatient settings and preventing readmissions,” the AMA said.

“Medicare’s acceptance of the new codes signals that CMS recognizes the important role these services have in improving the overall quality of health care,” said AMA President-elect Ardis Dee Hoven, MD. “The decision supports the work involved in transitioning patients from one care setting to the next and physicians working in emerging models of care.”