Page 5 - ACO REPORT MARCH 2022

The Right Post-Discharge Provider Supports
Value-Based Care Objectives
Slash Medicare Readmissions through Better Data Analytics

Fiscal year 2021 was a difficult sion rates. For example, helping stake-
year for hospital Medicare reimburse- holders pick the right post-discharge
ment. Medicare “will cut payments to provider type—home health agency or
83% of the 3,080 hospitals evaluated” nursing home. When a nursing home is
under the Hospital Readmissions Reduc- the right provider, hospital staff and
tion Program. Reimbursement reduc- physicians can influence patient choice
6
tions “from 0.01% to the maximum of to an entity with good support staff and
3.0%” will compound the financial chal- programs concurrent with a history of
7
lenges emanating from the Covid pan- low readmissions back to hospitals.
demic. Illustrating the importance of the
Research shows on average analytics, a study by 2CY, Inc. shows the
“patients discharged to home healthcare wide variation in readmissions back to
had a 5.6% higher 30-day readmission hospitals from Florida nursing homes.
rate than similar patients discharged to a (See following table.)
skilled nursing facility (SNF). 8
Distribution of Risk Adjusted
• For the patient, there is no mortality Readmission Rates
or functional outcomes differences Florida Nursing Homes
11
between the two groups.
9
Number of

• For Medicare, Medicare Advantage Readmission Rate Nursing Percent
Homes
plans, and all other entities interest-
ed in providing value based care, < 18.00% 69 11%
home health care is significantly less 18.00% to 18.49% 50 8%
expensive; “an average savings of 18.50% to 19.49% 103 16%
$4,514 in total Medicare payments in
the 60 days after the first hospital ad- 19.50% to 20.49% 141 22%
mission.” 20.50% to 21.49% 99 15%
10
21.50% to 22.49% 76 12%
All payors want patients referred
to the lowest cost site of care. But hospi- 22.50% to 23.49% 54 8%
tals don’t want unnecessary readmis- 23.50% to 24.49% 31 5%
sions; they pay a financial penalty for 24.50% to 25.49% 14 2%
higher 30-day risk-standardized read-
mission rates (RSRRs) for several condi- 25.50%+ 9 1%
tions. Total Nursing 646 100%
Value-based purchasing analytics Homes
can positively impact hospital readmis-
Source: CMS data and 2CY data analytics

5