Value-based Reimbursement Bringing Down Hospital Admissions

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

The transformation of healthcare ­– including the formation of ACOS, other value-based reimbursement models and use of post-acute care services in community settings – is having a noticeable effect on hospital admissions, a new study reveals.

Published on the Health Affairs blog site, the study by healthcare consultants Kaufman, Hall & Associates Inc. focused on the likely effects of value-based reimbursements between 2010 and 2012 in the seven-county greater Chicago area that represents just under 3% of the U.S. population. Data shows that hospital discharges dropped by 47,000 between the two years. The authors note that inpatient hospital use has been in decline but point out that hospital utilization rates per 1,000 declined in all age groups, including an 8%-9% drop in usage among patients 65 and older.

Examining the data more closely, the authors looked to the Agency for Healthcare Research and Quality’s Prevention Quality Indicators as they relate to hospital ambulatory care sensitive admissions (ACSAs). The agency has identified 16 admissions that are “sensitive” to ambulatory care, including diabetes, hypertension, adult asthma and chronic obstructive pulmonary disease (COPD) – all of which are conditions where home healthcare excels in treating patients in their homes.

“A reduction in ambulatory care sensitive admissions to hospitals would suggest that providers are doing a better job of managing patients’ chronic conditions, keeping patients with ambulatory sensitive conditions out of hospitals by meeting their prevention and care needs in outpatient and home settings,” the authors wrote.

In the home health and hospice industries, you do a terrific job at your core competency – providing quality care in patient homes, and in the case of hospice, providing care to patients and families in a dignified manner at life’s end.

But in order to compete in this new world of value-based reimbursement, waiting for patients to leave acute-care settings and choose your agency for home health no longer will be sufficient. If your agency isn’t working closely with care providers in your community to identify potential partnership opportunities, it certainly should be.

At the same time, you need to maximize agency operations through the effective use of home health documentation and clinical decision support tools that can be leveraged at the bedside.

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