Becker's Hospital Review

19 Financial Management The Costs of 10 Top Medicare Readmission Conditions By Bob Herman Readmissions added $41.3 billion in hospital costs in 2011, and 58 percent of those costs stemmed from Medicare patients. Those findings come from an April Agency for Healthcare Research and Quality statistical brief. All told, Medicare patients represented 56 percent of all readmissions in 2011. The three most common conditions for a Medicare readmission were congestive heart failure, septicemia and pneumonia, and all three were also the most expensive. Com- plications of devices, implants or grafts were the 10th most common readmission condition, but they were the sixth most expensive. Here are the costs of the 10 most common Medicare readmissions, according to the AHRQ brief. Note: Costs were defined as the actual expenses incurred in the production of hospital services (such as wages, supplies and utility costs). A read- mission was defined as a patient who was hospitalized within 30 days of a previous hospital admission. 1. Congestive heart failure — $1.75 billion (134,500 total readmissions) 2. Septicemia (except in labor) — $1.41 billion (92,900 total readmissions) 3. Pneumonia (except caused by tuberculosis or STDs) — $1.15 billion (88,800 total readmissions) 4. Chronic obstructive pulmonary disease and bronchiectasis — $924 million (77,900 total readmissions) 5. Cardiac dysrhythmias — $835 million (69,400 total readmissions) 6. Complication of device, implant or graft — $742 million (47,200 total re- admissions) 7. Heart attack — $693 million (51,300 total readmissions) 8. Acute and unspecified renal failure — $683 million (53,500 total readmis- sions) 9. Urinary tract infections — $621 million (56,900 total readmissions) 10. Acute cerebrovascular disease — $568 million (45,800 total readmissions) n CMS: 25% of Physicians Account for Most Medicare Spending By Helen Adamopoulos This past spring, CMS gave the public unprecedented access to Medicare physician payment data. The data set included information on more than 880,000 healthcare professionals across the country who received a total of $77 billion in Medicare Part B fee-for-service pay- ments in 2012. With the data, it's possible to compare 6,000 different types of services, procedures and payments re- ceived by individual providers, according to HHS. The New York Times analyzed the data and found a small frac- tion of physicians account for a significant amount of Medi- care spending. According to the Times, about 2 percent of physicians received a total of about $15 billion in Medicare payments. Furthermore, only 25 percent of physicians ac- counted for 75 percent of Medicare spending. In 2012, 100 physicians — mainly eye and cancer specialists — received a total of $610 million from Medicare, according to the analysis. The American Medical Association has released a statement saying that while the organization is "committed to trans- parency and the availability of information for patients to make informed decisions about their medical care," it had some concerns about CMS' release of physician data. "We believe that the broad data dump by CMS has signifi- cant short-comings regarding the accuracy and value of the medical services rendered by physicians," AMA President Ardis Dee Hoven, MD, said in the statement. "Releasing the data without context will likely lead to inaccuracies, misin- terpretations, false conclusions and other unintended con- sequences." CMS' landmark release of physician payment data builds on the agency's decision earlier this year to evaluate Free- dom of Information Act, or FOIA, requests from the media on a case-by-case basis for individual Medicare payments made to physicians. n This practice continues to provide HSS with opportunities to ensure future success by build- ing on best practices embedded in our organi- zation's culture to continually raise the bar for excellence; measuring outcomes and rewarding behaviors that promote our goals and culture, teaching new skills to adapt to the changing external environment and promoting a culture of innovation that provides a safe, empowering environment for members of the HSS family to offer constructive feedback and champion new ideas and processes. Tim Stover, MD. President and CEO of Akron (Ohio) General Health System: The Akron General Health System has invested many millions of dollars over the past two decades to develop its three Health & Wellness Centers, large outpatient community-based facilities that bring together a range of clinical outpatient services with exercise and retail-oriented health services, all in an effort to improve the health of our community. The focal point of each of Akron General's Health & Wellness Centers is its LifeStyles medical fitness facility, a state-of-the-art fitness center where ex- ercise programs are directed by physicians and fo- cus on the prevention and treatment of lifestyle- related disease, illness and injury through regular participation in medically supervised physical ac- tivity, nutrition and health education. This effort has resulted in better health for thousands in our community. n

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