Sizing Incentives to Reduce Avoidable Admissions

Friday, December 18th, 2009
This post was written by Melanie Matthews

Medication reconciliation, discharge planning, communication and teamwork across settings are all activities that can help hospitals reduce the number of avoidable hospital admissions. That’s why the Maryland Health Services Cost Review Commission (HSCRC) wants to help fund an infrastructure to support hospitals that do a better job at these functions, explained Dianne Feeney, the HSCRC’s associate director of quality initiatives, during a recent webinar on aligning reimbursement to reduce avoidable hospital admissions.

“We’re in the planning stages of this infrastructure support phase now,” said Feeney. “Other areas of infrastructure coordination across settings include shared care information, self-care management focus, joint clinical care protocols and shared single assessment templates. Nursing homes potentially need to be working with the hospitals who commonly have patients that go back and forth between the two entities. They should share certain kinds of protocols for certain patient types, for instance.
Then there may be some more broad efforts that are systemic problems like physician/patient communication. How do we improve that? Inappropriate use of 911 in the state and inappropriate use of emergency departments can also impact the readmission picture that we are seeing.

“Payment incentives for these activities are the hard nut to crack because hospitals’ bread and butter is getting the patients to come in the doors,” Feeney continued. “You have to size the incentive to make it attractive enough so that the hospital wants to go for it and reduce readmissions without losing their margin to be able to operate. The truth be known, there are probably just too many hospital beds, and there will be some shrinking of the inpatient hospital bed number because there is too much care being provided. At the same time, we still do have to set up the incentives and structure them such that hospitals will see reducing rate of admissions as a very positive thing to their bottom line.”

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