Medicare, CMS, Hospitals, and Unnecessarily Institutionalization.

Medicare, CMS, Hospitals, and Unnecessarily Institutionalization. Information Bulletin # 334 (6/2011).

There’s been a number of news articles recently stating that CMS will track hospital spending for Medicare recipients and will reward hospitals that keep costs down and penalize hospitals for costs incurred within 90 days after the person leaves the hospital.

It’s a “Medicare spending per beneficiary” device to measure hospital performance. For example, we have national data for infections occurring after surgery and/or as a result of just being in a hospital. Hospitals with much higher rates will be penalized. Similarly, there’s national data for heart attack mortality rates against which hospitals can be compared, rated, and then rewarded or penalized.

Obviously, besides improving medical care, rewards/penalties are an important strategy to control health costs, something everyone agrees is necessary.

We have a simple suggestion for CMS.

How about CMS including in its “Medicare spending per beneficiary” the measure of placement in nursing homes directly from acute care hospitals? This could actually be easily implemented because CMS could actually enforce its own federal regulations which require hospitals to do real and meaningful “discharge planning”?

CMS has national data by hospital. The federal “discharge planning” regulations require hospitals to identify at an “early stage of hospitalization” people likely to need post-hospital services. Discharge plans must include “appropriate arrangements for post-hospital care ... before discharge.”

Here’s a radical idea - save federal funds, both Medicare and Medicaid, by using the existing regulations to reward and penalize hospitals which do not arrange for home and community-based services and which have higher rates of nursing home placement.

Yes, stop the dumping of people from hospitals to nursing homes. It is outrageous, let alone unnecessarily expensive, that more than 60% of people in nursing homes come directly from acute care hospitals.

It’s no secret that hospital discharge planning does not take home and community-based services seriously. It’s no secret that a primary goal of the hospital is to save money, especially if its nonreimburseable. Therefore, hospitals will do everything to get the person “out of the hospital” as soon as the reimbursements will likely cease, even if it means dumping the person in a nursing home.

CMS - you have a financial interest, the regulatory authority, as well as an interest in the ADA’s mandate that services be provided “in the most integrated setting appropriate,” to address hospital dumping.

Include in the “Medicare spending per beneficiary” plan a measure of post-hospital placements. Reward hospitals that place people in the community with services and penalize hospitals with the worst dumping scores.

Steve Gold, The Disability Odyssey continues

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