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From Health Law Daily, August 28, 2014

Finally, hospital readmissions guidance that focuses on Medicaid

By Sarah E. Baumann, JD

Incentive programs and guidance aimed to reduce hospital readmissions rates have generally been targeted at the Medicare population.HHS’ Agency for Healthcare Research and Quality (AHRQ) is trying to change that by issuing its “Hospital Guide to Reducing Medicaid Admissions” to provide hospitals. The guide, developed over a two-year period, provides suggestions on improving transitional care strategies to meet the needs of adult Medicaid patients.

Medicaid readmissions. According to the AHRQ, adult Medicaid patients have the highest readmission rates of any payer. Readmission rates for non-obstetric adult Medicaid patients ages 45-64 are 24 percent. Medicaid heart failure readmission rates are 30 percent, versus 25 percent for Medicare patients. Now that Medicaid expansion pursuant to the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) has been implemented, the Medicaid population will likely include newly covered adults with little health care experience.

Because incentive programs tend to focus on the Medicare fee-for-service population, suggestions for transitional care strategies are often based on geriatric health service research literature. Adult Medicaid recipients, however, differ from Medicare beneficiaries. Many are hospitalized for different types of infections, behavioral health conditions, and sickle cell disease.They may also face social barriers, such as low literacy, unstable housing, and poverty.All of these factors can affect effective transitions in care and need to be addressed.

Guidance. The guide provides steps for analyzing a hospital’s readmission reduction efforts and putting ideas into action. Hospitals looking to rethink their strategies should analyze their data to determine the root causes of readmission, inventory readmissions reduction efforts to and align them with the community, and synthesize that information to develop a portfolio of strategies to reduce readmission. They should then determine the bets methods for adopting those strategies, collaborating with partners, such as social services, county health departments, and Medicaid managed care plans. Finally, they should consider offering enhanced services to patients at a particularly high risk for readmission, ranging from tactics as simple as post-discharge phone calls to the creation of a multidisciplinary care team.

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