Becker's Clinical Quality & Infection Control

20 REDUCING READMISSIONS A lthough hospital readmis- sion rates have dropped across the country for certain conditions, an analysis of Medicare claims by e Wall Street Journal found patients reenter the hospital nearly as frequently, but under a different label: observation stays. Readmission rates at acute care hospitals in the U.S. dropped by about 9 percent from 2010 to 2013, although WSJ's analysis found rates of observation stays during that time increased by about 48 percent. at means the rise in observation stays accounted for roughly 40 percent of the decline in readmissions. When patients enter the hospital on an observation stay, the care they receive is oen indistinguishable from inpatient stays. But under observation, patients are not counted toward readmission tallies — a move that can help hospitals avoid penalties under the Hospital Readmissions Reduction Program. Due to the program, 2,592 hospitals currently face penal- ties due to high rates of 30-day readmissions. ose penalties are estimated to cost a combined $420 million. ere are also other reasons for the increase in observation stays, however. According to the Journal, "CMS in recent years has encour- aged hospitals to label more stays as observation, in part through its contracts with review claims," as an effort to cut costs. While the billing change may benefit hospitals and save Medi- care money, the move may not be good for patients. "Rebekah Gardner, an assistant professor at Brown University's medical school, said that if patients are returning to hospitals just as frequently, regardless of how their stays are labeled, it signals that patient care hasn't improved," according to the Journal. Additionally, patients' pock- etbooks are affected differently if they are billed for an observation stay as opposed to an actual inpa- tient admission. Medicare Part A pays for inpatient stays. If you are hospitalized on observation sta- tus, payment by Medicare is un- der Part B, which covers physician and outpatient services. Patients without Part B coverage are oen le with the bill for observation status, even though there was not a perceptible difference in the type or level of care they received in the hospital. Further, Medicare does not cover skilled nursing facility stays unless the patient was admitted as an inpatient for a minimum of three nights. n Are Hospitals Lowering Readmissions or Just Putting More Patients Under Observation? By Heather Punke California Pilot Project Aims to Cut Cardiac Readmissions With Preemptive House Calls By Max Green A pilot program involving the Glendale (Calif.) Fire Department, the University of California Los Angeles' Center for Prehospital Care and Glendale (Calif.) Adventist Medical Center is working to reduce readmissions for recently discharged cardiac patients by paying them visits at home. Patients with congestive heart failure are especially bur- densome on readmission metrics, Steve Rottman, MD, di- rector of UCLA's Center for Prehospital Care, told Southern California Public Radio. About 25 percent of those patients are readmitted within 30 days, he said. Paramedics who visit the homes of recently discharged patients as part of the program review their diet and fluid intake take measurements, such as blood sugar level, temperature and pulse, and run electrocardiograms. Once a patient gives consent to be included in the program, a paramedic will be dispatched to their home within 72 hours of discharge. n

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