NCQA creates all-cause readmissions measure
First time this measure will be reported
The National Committee for Quality Assurance (NCQA) has created a new measure — now endorsed by the National Quality Forum (NQF) — that will require health plans for the first time to report all readmissions that occur within 30 days of discharge — something that happens to about a fifth of Medicare patients.
"Our vision in doing this is not to create an additional hassle for hospitals," says Robert Saunders, assistant vice president of research and analysis. "But we have never asked this in the past. We have never measured readmissions."
It seems strange, particularly given all the emphasis on preventing unplanned readmissions, that this hasn't been measured, he says. Certainly one key to making meaningful reductions is doing so.
Indeed, says Mary Barton, NCQA's vice president of performance measurement, this is a huge topic of interest now, and hospitals will soon be able to make use of this data to influence downward their own 30-day readmission rates.
Barton says she envisions hospitals being able to begin doing things before any patient even comes to the hospital — to either prevent an admission to begin with, or to ensure a stay is no longer and no shorter than it has to be to ensure the discharged patient goes home and stays there. "This should be welcomed by hospitals as a way to start doing things that will smooth a visit and wrap around the entire continuum of care to prevent readmissions," she says.
There is so much that can go wrong in a hospital — not that it always happens, or even often happens at every hospital, Barton continues. Patients are sicker and more complex than they have ever been. "You have to do things to ensure you don't create new problems. You have to titrate treatment levels to a sick person and then make sure they are changed appropriately during the stay and again after discharge."
Saunders says that this new measure will give plans and hospitals a good peg for partnering together on this issue. "Hospitals often feel that the further away on the calendar a patient is from discharge, the less control they have," he notes. "This measure will offer you another way in to improve care coordination."
Hospitals are scurrying now to affect readmission rates in any way they can — having pharmacists make follow-up calls to patients after discharge, working with primary care providers to ensure easy access to follow-up appointments, and helping physicians improve hand-offs and communication. "Cynical people often say they want to do this to save money, or that CMS wants to save money," Barton says. "It's more accurate to say that we see a quality problem that has an answer. There are concrete things that can and should be done. But we have to line up the incentives." Part of that includes measuring the problem and creating a starting point for discussions between hospital and health plan on how all areas of care can work together to reduce this.
And making it the plan that has to report these figures? Well, that puts more pressure on the plan to do something to fix a problem that had always been viewed as that of hospitals. "It's not just a hospital problem," Saunders concludes. "And health plans are in a position to do something about it."
For more information on this topic, contact Mary Barton, Vice President of Performance Measurement or Robert Saunders, Assistant Vice President, Research and Analysis, NCQA. Washington, DC. Telephone: (202) 955-3200.
The National Committee for Quality Assurance (NCQA) has created a new measure now endorsed by the National Quality Forum (NQF) that will require health plans for the first time to report all readmissions that occur within 30 days of discharge something that happens to about a fifth of Medicare patients.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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