When MedPAC recommended to Congress in March that readmission penalties similar to those imposed on hospitals be applied to home healthcare organizations, the home health industry didn’t balk because it has already been working toward reducing readmissions.
“Hospitals are major referral sources to home health organizations and they want agencies that can show that they have low levels of hospital readmissions,” said H. Carol Saul, a partner in the healthcare and life science practice at Atlanta law firm Arnall Golden Gregory.
More savvy home health organizations have already been using low readmission rates as a marketing tool, Saul said. She has seen some with specialty programs focusing on clinical conditions tied to readmission penalties – heart failure, pneumonia and heart attacks.
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“There is already a lot of innovation going on around this and it is one example of how the Affordable Care Act is standing some old things on their head,” Saul said.
Moving from hospitals to other providers is a natural progression, said Barbara McCann, chief industry officer for Interim HealthCare, a home care company based in Sunrise, Fla. She said she doesn’t think the industry is being “picked on”; accountability is moving from hospitals into other industries and readmissions is a logical measurement, she said.
“This is a message to the industry that we are joining the rest of the system with accountability,” she said. “That is important, and if you can’t perform, there will likely be fallout for you.”
The potential penalties wouldn’t be too unusual for the industry as there is already “soft” pressure to reduce readmissions. Other payers are tracking these numbers and hospitals are looking to partner with groups that keep readmissions low.
Because of that “soft” pressure, the industry has already implemented strategies to reduce readmissions, including increased use of telehealth services, using transition coordinators with patients leaving the hospital and filling and reconciling prescriptions as soon as possible after hospital discharge.
Going forward, said Rhonda Richards, senior legislative representative responsible for long-term care at AARP, said the industry will likely focus more on things like supporting, educating and training a patient’s caregiver and fostering communication between providers after discharge. They may also place more focus on things that tend to increase readmissions directly like tripping hazards.
While the industry is already on the road to reducing readmissions, and largely supportive of pay-for-performance and value-based models, said William Dombi, National Association for Home Care and Hospice’s vice president for law, said the group would prefer a carrot and stick approach, rather than just the stick.
“We support (MedPAC’s recommendations) as one half of a system – we don’t support it solely,” he said.
One challenge facing readmissions penalties for the home healthcare industry will be determining the cause of readmission, Dombi said.
The problem could be premature discharge by the hospital, an oversight of the home health agency, or something unrelated to either organization. He said he would like to see some sort of differentiation for the two sectors – a hospital’s fault from five to seven days after discharge and home health’s 30 to 60 days after, for instance.
Dombi foresees three outcomes for home health providers in the face of legislated readmissions penalties. One part of the industry will likely ramp up performance to avoid penalties or gain rewards; another will assume what they are doing is fine; and a third portion will figure that the cost of improving performance will outweigh the cost of any penalties.
But first, the recommendations would have to move forward. MedPAC’s recommendations have yet to be approved by Congress and no specifics, such as the readmissions rate that would initiate a penalty, have been determined.
Dombi said he has talked with congressional staff, who have told him they don’t think the issue is right for prime time. He said a more robust and accurate risk adjustment system will need to be created, and congressional lawmakers have higher priorities.