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Readmission Penalties For Diabetes

Reducing Hospital Readmissions Rates: How To Avoid Upcoming Penalties And Maintain Patient Wellness

Reducing Hospital Readmissions Rates: How To Avoid Upcoming Penalties And Maintain Patient Wellness

Reducing Hospital Readmissions Rates: How to Avoid Upcoming Penalties and Maintain Patient Wellness With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a leading symptom of a costly and uncoordinated health system. In order to address this problem, CMS created quality programs that reward healthcare providers and hospitals with incentive payments for using electronic health records in order to promote improved care quality and better care coordination. In the coming years, these incentive "carrots" will soon turn into penalty "sticks." By 2017, CMS will penalize providers and hospitals up to 8 percent of their Medicare payments based on various performance indicators. According to Kaiser Health News , they state that there is a possibility of forfeitingmore than$280 million in Medicare funds in 2013, hospitals are looking for innovative and cost effective solutions to reduce readmission rates and provide the highest quality of care. Legislation history and escalating penalties In 2010, the Patient Protection and Affordable Care Act charged HHS with creating a program that would reduce the rate of patient readmission to hospitals. This program, called the Readmissions Reduction Program, became effective for all discharges on Oct. 1, 2012. Outlined in the CMS guidelines , the program defines "readmission" as "an admission to a hospital within 30 days of a discharge from the same or another hospital." According to CMS, the rising rate of readmissions points to a decline in of the quality of care in hospitals. CMS has proposed solutions that could reduce the rate of readmissions by instating penalties for hospitals whose rates of readmission exceed a certain percentage. In October of 2012, h Continue reading >>

Medicare Readmission Penalties For Hospitals Continue

Medicare Readmission Penalties For Hospitals Continue

Medicare Readmission Penalties for Hospitals Continue Amid all the turbulence over the future of the Affordable Care Act, one facet continues unchanged: President Donald Trump's administration is penalizing more than half the nation's hospitals for having too many patients return within a month. Medicare is punishing 2,573 hospitals, just two dozen short of what it did last year under former President Barack Obama, according to federal records released Wednesday. Starting in October, the federal government will cut those hospitals' payments by as much as 3 percent for a year. Medicare docked all but 174 of those hospitals last year as well. The $564 million the government projects to save also is roughly the same as it was last year under Obama. High rates of readmissions have been a safety concern for decades, with one in five Medicare patients historically ending up back in the hospital within 30 days. In 2011, 3.3 million adults returned to the hospital, running up medical costs estimated at $41 billion, according to the federal Agency for Healthcare Research and Quality. The penalties, which begin their sixth year in October, have coincided with a nationwide decrease in hospital repeat patients. Between 2007 and 2015, the frequency of readmissions for conditions targeted by Medicare dropped from 21.5 percent to 17.8 percent, with the majority of the decrease occurring shortly after the health law passed in 2010, according to a study last year in the New England Journal of Medicine conducted by Obama administration health policy experts. Some hospitals began giving impoverished patients free medications that they prescribe for their recovery, while others sent nurses to check up on patients seen as most likely to relapse in their homes. Readmissions dropped more qui Continue reading >>

Diabetes Education Cuts Hospital Visits

Diabetes Education Cuts Hospital Visits

Inpatient Diabetes Education Is Associated With Less Frequent Hospital Readmission Among Patients With Poor Glycemic Control, Diabetes Care, October 2013 What is the problem and what is known about it so far? After an initial hospital admission, one out of five people with diabetes will return to the hospital within 30 days. The health and financial effects of hospital readmission are significant. Why did the researchers do this particular study? The researchers wanted to check if diabetes education, given to a patient while in the hospital, could reduce the readmission rate. The study included 2,265 patients with diabetes and an A1C (a measure of the average blood glucose levels over the previous two to three months) over 9 percent who were hospitalized between 2008 and 2010. The researchers analyzed readmission data from the patients, comparing those who received training from a diabetes educator while in the hospital and those that didn't. 11 percent of participants who received diabetes education were readmitted to the hospital within 30 days, compared to 16 percent of those who did not receive the training. Its unclear whether the findings would extend to people with lower A1C levels. Also, the data collection was limited to a single hospital, so if participants were admitted to a different hospital, the data would not show that. Hospital admissions may provide an opportunity to offer diabetes education to help patients avoid readmissions, improving health and lowering costs. Continue reading >>

Linking Readmission, Reimbursement Exposes Complex Needs Of Diabetes Patients

Linking Readmission, Reimbursement Exposes Complex Needs Of Diabetes Patients

Linking Readmission, Reimbursement Exposes Complex Needs of Diabetes Patients Coverage from the 2017 meeting of the American Association of Diabetes Educators. Few elements of the Affordable Care Act (ACA) have forced health systems to rethink their role in patients lives like the penalties Medicare charges if they fare poorly on 30-day readmission rates. While the Hospital Readmission Reduction Program has sparked debate since it started in 2012, it has forced healthcare staff to reach into the community, to ask why some patients land back in the hospital and others dont. With the earliest 30-day measures measuring how many returned after heart attacks, heart failure, and pneumonia, patients with diabetes quickly captured health systems attention since they were likely candidates for readmission. What hospitals are learning, according to a speaker at the American Association of Diabetes Educators annual meeting in Indianapolis, Indiana, is that a patients diabetes may not be first on the list of health problems. That makes successful interventions complicated, and it often means that solutions must be customized to a patients unique needs. Virginia Peragallo-Dittko, RN, CDE, BC-ADM, FAADE, executive director of the Diabetes and Obesity Institute of NYU Winthrop Hospital and professor of Medicine at Stony Brook School of Medicine, told educators gathered Saturday that the right model for reducing readmissions doesnt have the hospital at the topit has the community at the top. Transitions are going to look different, she said. While the ACA has forced changes and things have improved, theres still a long way to go. The challenges start even before the patient leaves the hospital, Peragallo-Dittko said. If a patient is diagnosed with diabetes in the hospital, it can take Continue reading >>

Inpatient Diabetes Education Reduces Readmissions Rate

Inpatient Diabetes Education Reduces Readmissions Rate

Inpatient Diabetes Education Reduces Readmissions Rate Inpatient diabetes education was associated with 34% reduced risk of all-cause readmissions within 30 days, and 20% reduced risk of readmissions at 180 days, after adjustment for other potentially confounding variables, in a retrospective study published in Diabetes Care. Hospital readmission is an important contributor to total medical expenditures and an emerging indicator of quality of care, said Sara J. Healy, MD, endocrinology fellow at Ohio State University Wexner Medical Center in Columbus, Ohio. Hospitals have started to incur penalties for readmission within 30 days for certain conditions and other medical conditions are expected to be added, Dr. Healy said. The objective of the retrospective study was to explore the relationship between inpatient diabetes education, conducted by a dedicated trained diabetes educator, and hospital readmissions in patients with poorly controlled diabetes (A1C>9%) hospitalized between 2008 and 2010, Dr. Healy said. A total of 2,265 patients was included in the 30-day analysis, and 2,069 patients were included in the 180-day analysis. Most of the patients were initially admitted for reasons other than uncontrolled diabetes. Inpatient Diabetes Education Linked to 34% Reduced Risk for Readmission Patients who received inpatient diabetes education (IDE) had a lower frequency of readmission within 30 days than did those who did not (11% vs 16%; P=0.0001), Dr. Healy said. After adjusting for sociodemographic and illness-related factors, IDE was associated with a lower risk for readmission (odds ratio, 0.66; P=0.001). Other independent predictors of readmission included Medicaid insurance and longer hospital stay. The beneficial effect of diabetes education on reduced risk for hosp Continue reading >>

The Relationship Between Diabetes Mellitus And 30-day Readmission Rates

The Relationship Between Diabetes Mellitus And 30-day Readmission Rates

It is estimated that 9.3% of the population in the United States have diabetes mellitus (DM), 28% of which are undiagnosed. The high prevalence of DM makes it a common comorbid condition in hospitalized patients. In recent years, government agencies and healthcare systems have increasingly focused on 30-day readmission rates to determine the complexity of their patient populations and to improve quality. Thirty-day readmission rates for hospitalized patients with DM are reported to be between 14.4 and 22.7%, much higher than the rate for all hospitalized patients (8.513.5%). The objectives of this study were to (1) determine the incidence and causes of 30-day readmission rates for patients with diabetes listed as either the primary reason for the index admission or with diabetes listed as a secondary diagnosis compared to those without DM and (2) evaluate the impact on readmission of two specialized inpatient DM services: the Hyperglycemic Intensive Insulin Program (HIIP) and Endocrine Consults (ENDO). For this study, DM was defined as any ICD-9 discharge diagnosis (principal or secondary) of 250.xx. Readmissions were defined as any unscheduled inpatient admission, emergency department (ED) visit, or observation unit stay. We analyzed two separate sets of patient data. The first pilot study was a retrospective chart review of all patients with a principle or secondary admission diagnosis of diabetes admitted to any adult service within the University of Michigan Health System (UMHS) between October 1, 2013 and December 31, 2013. We then did further uncontrolled analysis of the patients with a principal admitting diagnosis of diabetes. The second larger retrospective study included all adults discharged from UMHS between October 1, 2013 and September 30, 2014 with princ Continue reading >>

How To Use Machine Learning To Predict Hospital Readmissions? (part 1 | Part2)

How To Use Machine Learning To Predict Hospital Readmissions? (part 1 | Part2)

Physician turned manager, turned information scientist. My passion is designing technology solutions that help us make better health decisions. More: uraza.me How to use machine learning to predict hospital readmissions? (Part 1 | Part2 ) Whats in this article: This post describes how you can apply simple machine learning techniques to analyze healthcare data in interesting and meaningful ways. We use as an example, prediction of hospital readmission in diabetic inpatients, and explain how we achieved 94% accuracy. This post is the result of a project done by a team of four ( Usman Raza , Harman Shah Singh , Ching-Yi Lin and Rohan Kar ), and further reshaped for your reading pleasure by Harman and myself . We will take you through the process, highlighting rationales for our choices, and getting a bit into the Python code at certain points. Note: Although this is meant to be accessible to most, some familiarity with python and pandas is assumed. Why hospital readmissions matter? (for healthcare professionals) A hospital readmission is when a patient who is discharged from the hospital, gets re-admitted again within a certain period of time. Hospital readmission rates for certain conditions are now considered an indicator of hospital quality, and also affect the cost of care adversely. For this reason, Centers for Medicare & Medicaid Services established the Hospital Readmissions Reduction Program which aims to improve quality of care for patients and reduce healthcare spending by applying payment penalties to hospitals that have more than expected readmission rates for certain conditions. Although diabetes is not yet included in the penalty measures, the program is regularly adding new disease conditions to the list, now totalling 6 for FY2018. In 2011, American hospit Continue reading >>

Diabetes: Hospitals Ramping Up Inpatient Care

Diabetes: Hospitals Ramping Up Inpatient Care

Diabetes Framing the Issue Diabetes is common in the hospital. The condition was a primary or secondary diagnosis in more than 5.3 million hospital discharges in 2010. The disease puts patients at higher risk of serious complications in the hospital. These include dangerous blood sugar levels, falls, infections and pressure ulcers. Medicare penalties for excess readmissions and high rates of health care-acquired conditions make blood sugar control a high priority for hospitals. Diabetes as a principal or secondary diagnosis can increase patient lengths of stay, which decreases hospital revenue. The mean length of stay for diabetic patients was 5.3 days in 2008, compared with 4.4 days for patients without the condition. At any given time, one-third or more of patients in most hospitals have high blood sugar, typically caused by diabetes. These patients are at higher risk of serious complications: infections, falls, pressure ulcers and harmful or even deadly high or low blood sugar swings. Medicare payment penalties for having high rates of health care-acquired conditions and for excess readmissions mean that hospitals must have systems in place to manage patients' blood sugar or run the risk not only of bad patient outcomes, but also financial losses. "What hospitals should be doing is identifying diabetic patients when they come in and doing whatever they can to prevent that patient from getting any kind of hospital-acquired issue," says Hazel R. Seabrook, a managing director at Huron Consulting Group, Chicago. But inpatient stays have to include more than blood sugar management. "Hospitals should also do appropriate discharge planning for diabetic patients so the patient gets discharged to the next care setting with the right education and the right follow-up care, so Continue reading >>

Health Reform Brings Heavy Fines For Hospitals With High Readmissions

Health Reform Brings Heavy Fines For Hospitals With High Readmissions

Health Reform Brings Heavy Fines for Hospitals With High Readmissions Should hospitals be held accountable for what happens to patients once theyre discharged? A new policy under the Affordable Care Act says yes. Photos by Jim Petit. The federal government began fining hospitals based on how many Medicare patients were readmitted within 30 days of discharge in October. They track three specific conditions heart failure, congestive heart failure and pneumonia. The goal is to improve the quality of care for seniors by preventing return trips to the hospital and save the government millions (a whopping $17.5 million dollars this year alone ) in the form of fines to the hospital, based on their readmission rate. In 2010, nearly one in five Medicare patients returned to the hospital within a month of discharge. Many hospitals are now working on more aggressive ways to follow-up with seniors in the first 30 days, to avoid a readmission. Since October, the policy has been widely studied , reported and analyzed . And its penalties have been revised. On Fridays PBS NewsHour, health correspondent Betty Ann Bowser examines how the policy is unfolding at a medical center in Boston. Tune in for the full report. For a broader overview, we spoke to Kaiser Health News reporter Jordan Rau recently. Hes been following the policy since the Affordable Care Act was passed in 2009. NEWSHOUR: Jordan, thank you so much for joining us. First of all, what do readmission rates tell us about a hospital? And is it something that consumers can use as a tool? JORDAN RAU, Reporter, Kaiser Health News: On the face of it, they tell you how a hospital and the post-acute care that a patient gets after leaving worked, how well they performed in making sure patients follow everything that they need to do t Continue reading >>

Explore Hospital Readmissions In Louisiana | 2016 Senior Report | Ahr

Explore Hospital Readmissions In Louisiana | 2016 Senior Report | Ahr

Able-bodied All Determinants - Senior All Outcomes - Senior Behaviors - Seniors Clinical Care - Seniors Community & Environment - Macro - Seniors Community & Environment - Micro - Seniors Community & Environment Total - Seniors Community Support Dedicated Health Care Provider - Seniors Dental Visit - Seniors Diabetes Management Early Death - Seniors Excessive Drinking - Seniors Falls - Seniors Flu Vaccine - Seniors Food Insecurity - Seniors Frequent Mental Distress - Seniors Geriatrician Shortfall Health Screenings - Seniors High Health Status-Senior Hip Fractures Home Health Care Home-delivered Meals Hospice Care Hospital Deaths Hospital Readmissions ICU Use Low-care Nursing Home Residents Nursing Home Quality Obesity - Seniors Overall - Senior Pain Management Physical Inactivity - Seniors Policy - Seniors Poverty - Seniors Prescription Drug Coverage Preventable Hospitalizations - Seniors Recommended Hospital Care-Seniors Smoking - Seniors SNAP Reach Teeth Extractions - Seniors Underweight - Seniors Volunteerism Chronic Drinking - Seniors Cognitive Difficulty - Seniors Depression - Seniors Diabetes - Relative Change from 1999 to 2014 Education - Seniors High Health Status - Relative Change from 1999 to 2014 Multiple Chronic Conditions - Seniors Obesity - Relative Change from 1999 to 2014 Overuse--Mammography Overuse--PSA Test Poor Mental Health Days - Seniors Smoking - Relative Change from 1999 to 2014 Social Support - Seniors Suicide - Senior Americas Heath Rankings charts are available for you to download for use in PowerPoint presentations, handouts, or wherever you choose! In the top right corner of any chart, press the download icon. You can also share a single chart, a whole measure, or a State page to Facebook or Twitter by looking for the share icon in the top Continue reading >>

Preventing Hospital Readmissions

Preventing Hospital Readmissions

In virtually every health insurance plan in the United States, hospitals and doctors are paid a set price for each service or procedure they perform. While this system makes sense in many ways, it has long been known to lead to an unfortunate set of incentives: Since hospitals get paid more for admitting more patients and performing more procedures, they have no natural financial interest in preventing future complications or hospitalizations resulting from the procedures they perform. As part of the Affordable Care Act (Obamacare), the 2010 health-care reform law, Congress tried to remedy this situation by tying certain Medicare payments to hospitals readmission rates following certain procedures. Specifically, as described last week in a Kaiser Health News article, Medicare the federal health insurance program for older adults and others began to look at readmissions after Medicare patients were hospitalized for five common reasons: heart attack, heart failure, pneumonia, a chronic lung condition, or hip or knee replacement. For each hospital, Medicare then compared the number of people readmitted within a month of each hospitalization with what it thought the number should be, based on the hospitals mix of patients and nationwide readmission rates. If a hospitals readmission rate is higher than Medicare thinks it should be, the agency penalizes that hospital during the next fiscal year by paying it less for hospitalizations in the five categories. Since these penalties began three years ago, readmissions have fallen, but about one in five Medicare patients still returns to the hospital within a month of being discharged. As noted in the Kaiser article, the amount of the Medicare penalty varies, and the number of hospitals penalized varies widely by state. The fines Continue reading >>

Study Finds Hospital Quality Report Cards And Readmission Penalties May Not Tell The Whole Story

Study Finds Hospital Quality Report Cards And Readmission Penalties May Not Tell The Whole Story

Study Finds Hospital Quality Report Cards and Readmission Penalties May Not Tell the Whole Story Lindsey Diaz-MacInnis [email protected], 617-667-7372 BOSTON Over the past several years, the Centers for Medicare & Medicaid Services (CMS) have reported hospital quality measures on the Hospital Compare website, providing the public with a way to compare hospital performance. Hospital readmission rates in particular have gained substantial attention from policymakers and health care providers because of their high frequency and significant costs. Among the most prominent of these are 30-day hospital readmission rates for specific conditions, including heart failure (HF), pneumonia and myocardial infarction (MI or heart attack) which are risk-adjusted to account for differences in patients health status. Higher-than-average 30-day readmission rates not only result in poor report cards for low-performing hospitals, but can also result in substantial financial penalties. Now new research finds that these condition-specific readmissions measures may not accurately or fairly reflect hospital quality. Led by researchers at the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center (BIDMC) and publishing online today in the Annals of Internal Medicine, the study found significant differences in hospitals performance when readmissions were assessed for non-Medicare patients and for conditions other than those currently reported, showing that when these additional factors are taken into account, half of hospitals would be subject to a change in their financial penalty status. As it currently exists, the Medicare public reporting system offers an incomplete picture, said senior author Robert W. Yeh, MD, MSc, Director of the Smith Center for Continue reading >>

Medicare Readmission Penalties Examined

Medicare Readmission Penalties Examined

Advice is given on how hospitals and clinicians can avoid the pitfalls of the penalty program, and how policymakers could change it to operate more effectively. On Dec. 6, 2013, the Centers for Medicare and Medicaid Services (CMS) announced successful results from the hospital readmission penalties program begun in 2012: 30-day readmissions had dropped from an average of about 19% in 2007-2011 to 18.5% in 2012 to under 18% in the first half of 2013. But on the very same day, thought leaders gathered at the National Readmission Summit in Washington, D.C. were critiquing the penalty program. They praised the penalties for effectively focusing attention on the problem of readmissions but expressed concerns about the program's potential effects, from increasing disparities in care to distracting hospitals from needed improvements. A 0.6% decline in the national readmission rate meant that 87,000 Medicare patients did not come back to the hospital, said Nancy Foster, vice president of quality and patient safety policy for the American Hospital Association. There's still room for improvement, however. CMS, you've done a good thing, agreed Amy Boutwell, MD, MPP, a hospitalist at Newton-Wellesley Hospital in Newton, Mass., and founder of Collaborative Healthcare Strategies, a company working on improving health care delivery. However, their good work has created some blinders for us in the field. The experts offered their thoughts on how hospitals and clinicians can avoid the pitfalls of the penalty program and how policymakers could change it to operate more effectively. One problem with the penalties is that they have focused hospitals on the particular diagnoses chosen by CMS. Heart failure, acute myocardial infarction and pneumonia are not the top 3 reasons for readmission Continue reading >>

Taking Steps In The Hospital To Prevent Diabetes-related Readmissions

Taking Steps In The Hospital To Prevent Diabetes-related Readmissions

Taking steps in the hospital to prevent diabetes-related readmissions Author: Scott J. Saccomano, PhD, GNP-BC, RN Despite the growth in scientific advances in management, diabetes continues to be a chronic disease plagued by frequent hospital readmissions. Patients with diabetes account for approximately 480,958 hospital in-patient stays per year with a 30-day readmission rate of 97,784, accounting for a 20.3% hospital readmission rate. Given these statistics, its not surprising that reducing readmission rates for patients with diabetes has become an important goal for hospitals and healthcare providers. And, given the number of people who will be diagnosed with diabetes in the future, emphasis on that goal is only likely to increase. Consider that currently 26 million people in the United States (8.3% of the population) have diabetes, and another 7 million people have undiagnosed diabetes. Estimates indicate an additional 2 million people 20 years and older are diagnosed with diabetes each year. Finally, estimates of people at risk for diabetes or people with pre-diabetes are approximately 79 million. As a nurse, you play a pivotal role in reducing readmission rates by participating in team initiatives related to patient education and self-management and by ensuring that preventing readmissions is addressed early during the hospital stay. Preventing diabetes-related hospital readmissions takes a multidisciplinary team that includes registered nurses, nurse practitioners, physicians, physician assistants, registered dietitians, pharmacists, social workers, nursing assistants, and certified diabetes educators (CDEs). (See About certified diabetes educators.) The team helps educate patients, serves as a resource to staff, and collaborates with other healthcare providers. Continue reading >>

Hospital Readmission Of Patients With Diabetes.

Hospital Readmission Of Patients With Diabetes.

Curr Diab Rep. 2015 Apr;15(4):17. doi: 10.1007/s11892-015-0584-7. Hospital readmission of patients with diabetes. Section of Endocrinology, Diabetes, and Metabolism, School of Medicine, Temple University, 3322 N. Broad ST., Ste 205, Philadelphia, PA, 19140, USA. [email protected] Correction to: Hospital Readmission of Patients with Diabetes. [Curr Diab Rep. 2018] Hospital readmission is a high-priority health care quality measure and target for cost reduction. Despite broad interest in readmission, relatively little research has focused on patients with diabetes. The burden of diabetes among hospitalized patients, however, is substantial, growing, and costly, and readmissions contribute a significant portion of this burden. Reducing readmission rates of diabetic patients has the potential to greatly reduce health care costs while simultaneously improving care. Risk factors for readmission in this population include lower socioeconomic status, racial/ethnic minority, comorbidity burden, public insurance, emergent or urgent admission, and a history of recent prior hospitalization. Hospitalized patients with diabetes may be at higher risk of readmission than those without diabetes. Potential ways to reduce readmission risk are inpatient education, specialty care, better discharge instructions, coordination of care, and post-discharge support. More studies are needed to test the effect of these interventions on the readmission rates of patients with diabetes. Continue reading >>

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