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Readmission-penalty pain

September 2013

Published in the September 2013 issue of Today’s Hospitalist

Hospitals to feel readmission-penalty pain

IN MEDICARE’S second round of penalties for preventable readmissions, two-thirds of eligible U.S. hospitals will take a hit to their reimbursement.

Starting Oct. 1, more than 2,200 hospitals will be assessed a penalty because of too-high 30-day readmissions for patients with heart attack, heart failure or pneumonia, according to Kaiser Health News. Among those hospitals, 18 will have their Medicare reimbursements reduced 2%, the maximum amount, while more than 150 will lose 1% or more. The maximum penalty during the first round of readmission penalties, which began October 2012, was 1%.

While the number of hospitals being penalized remains about the same as in the first year of the program, nearly 1,100 hospitals will see higher penalties; nearly 1,400 will pay a lower penalty. While readmission penalties during round one totaled $280 million, the total for round two drops to $227 million.

According to Kaiser Health coverage, hospitals treating larger numbers of low-income patients are “more likely to be penalized.”

Time to talk about sex

NOT UP TO SPEED on how to counsel MI patients about how and when to resume sexual activity? The American Heart Association (AHA) has published new guidance on how to provide that counseling to patients with cardiovascular disease, saying that it’s important for health care providers to start the discussion because patients may be too embarrassed to raise the issue.

According to the new guidance, strategies should include short-term counseling for patients in acute-care settings. Providers themselves, the new guidelines state, may need to be trained in communication techniques and sexual assessment and counseling.

While the AHA last year pointed out that sex is safe for most MI patients, the new consensus document “published online by Circulation “notes that clinicians should tailor their advice to individual patients and their partners. The document, which also includes “how-to” information on resuming sexual activity for patients who’ve had a heart attack or other cardiovascular condition, also points out that sexual counseling should be part of basic professional training and continuing education.

Observation: final rule, but any more clarity?

A NEW FINAL RULE from the Centers for Medicare and Medicaid Services (CMS) should bring “greater clarity” to the issue of which patients can appropriately be admitted, according to a CMS press release “but hospitals may find otherwise.

The new rule, which takes effect this October, notes that patients should be considered appropriate for admission (with bills paid from Medicare part A) if doctors expect patients to stay in the hospital at least two midnights for any procedure, test or treatment. The new rule further states that in assessing whether patients will stay in the hospital for that amount of time, doctors should include any time that patients spend in observation or the ED.

Patients expected to spend less time in the hospital will be considered appropriate for only observation status. The CMS estimates that the new rule will boost hospital Medicare charges by $220 million due to more admissions. To make the increases budget-neutral, Medicare will adjust hospital payments to offset that increase.

The final rule is designed to reduce the number of patients who remain in observation several days.

Strategies to help train Millennials

WHILE MUCH HAS BEEN MADE of the changes in medical education brought about by revised work hour rules, the authors of a recent article point to another big shift: how the learning styles of Millennials (those born between 1980 and 2000) differ from that of older doctors.

In an article published online by the Journal of Hospital Medicine, the authors note that Millennials have a much greater affinity for technology and innovation, prefer structured learning that includes interactivity and experiential training, and want to collaborate as well as get immediate feedback.

The authors identify several strategies to enhance teaching rounds for Millennials. Those include saving lectures and readings for self-study, devoting group time instead to interactive discussions, and making the most of technological devices and apps to enhance teaching at the bedside. Other recommendations include e-mailing studies after rounds for review and discussion and cloud-sharing important articles.