A more realistic approach to achieving accountable care

Hospitals that are already struggling financially to stay afloat face significant challenges in the coming months and years under some of the provisions of Obamacare.

Under the Affordable Care Act’s Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties.

The question is whether hospitals really have that much control over factors leading to readmission and whether they are really at fault.

Some readmissions are unavoidable, especially in patients who are elderly, poorly educated, and noncompliant. Many of the contributing factors to readmission in these scenarios are not necessarily attributable to a lack of poor care during the hospital stay, but rather to a number of care-coordination or compliance issues that involve the patient and/or the doctor subsequent to discharge.

The initial penalties, which took effect several months ago, were only for people readmitted for heart failure, myocardial infarction, or pneumonia. The list has now been extended to include those patients who may be readmitted following hip and knee replacements.

The unintended consequences of these reimbursement policies could ultimately impact the quality of care patients receive as hospitals will be reluctant to readmit for fear of incurring penalties.

The policies also put many academic hospitals and tertiary care centers at a disadvantage. These facilities often care for patients who are sicker, and it is the sicker population that may very well be prone to readmissions.

A key issue to reducing hospital readmissions in any scenario requires well-coordinated care. In fact, the framework of accountable care organizations has been designed to improve efficiencies in care delivery by providing incentives for a group of physicians caring for a patient.

The logic is, of course, that if there is a single bundled payment in which all doctors involved in the patient’s care will share, it will force greater efficiencies in delivery of that care.

In an ideal world this, in fact, may be the case, but achieving this utopia will be challenged by the lack of adequate information to enable hospitals, patients, doctors, and other care coordinators to effectively communicate and ensure that information doesn’t fall through the cracks.

A more realistic approach to achieving accountable care would have been to provide the necessary resources to ensure that every stakeholder, in fact, has the necessary tools and technology to enforce and measure coordination of care and quality. Although we have taken some early steps in the right direction, it may be premature to impose penalties on a system that is ill-equipped to deliver what’s being asked.

Sreedhar Potarazu is an ophthalmologist and founder and CEO of Vital Spring Technologies. He blogs at Business and Policy.

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