The Center of Medicare and Medicaid Services (CMS) is in charge of all affairs concerning the Medicare and Medicaid programs in the United States.
In determining the quality of performance by hospitals the board collects data from these hospitals and publicly reports the risk-standardized readmission rates (RSRRs). It is widely appreciated among health stakeholders that the data obtained by analyzing readmission rates serves as an indicator of quality of health care provided. The National Quality Forum has actually approved the use of this method to determine the performance by the hospitals. The data obtained from such surveys has also been used in policy formulation with significant interventions being employed to reverse or improve the situation in areas of target. Heart failure is one of the most common diagnostic elements in Medicare beneficiaries. Different hospitals record wide ranging rates of readmission in America depending on the quality of services provided. The CMS has over the years used intervention measures such as improving post discharge care through managed follow-ups and educational approaches.3
It is estimated that up to 20% of Medicare hospital bills are used to cater for re-hospitalization cases. Heart failure constitutes the highest proportion of these cases. The vulnerability of these patients following discharge is associated with post discharge therapies which may markedly differ from the ones used in hospitals.it is therefore vital that the physicians in charge carry a follow upon the patients to reduce cases of readmission.2 Over the last few years remarkable progress has been made in reducing the rates of readmission in hospitals partially due to advancement in the medical care provided particularly to heart failure patients. The use of drugs such as aldosterone antagonists and other modern therapies have reduced the readmission chances as they provide the appropriate post discharge therapy sustainable for months or years.1
According to a survey carried out by Ross Joseph et al and published in the journal of American Heart Association it was deduced that among the heart failure patients who were beneficiaries of the fee-for-service Medicare no significant changes in readmission rates were noted between 2004 and 2006. To conclusively assess this data comparative studies need to be carried out with other programs that do not use the fee-for-service payment structure. The current CMS policy focuses more on volume as opposed to quality of outcomes. The structure of the payment policy is more of an economic inducement to the health care providers so as to increase intensity and patient volume with an aim to raise more income. The CMS payments should instead be aimed at improving services that would in turn reduce the readmission rates. Efforts have been made of late to improve the CMS payment policy. The most recent has been the recommendation to realign the financial incentive and enhance collaborative approaches among health care providers such as hospitals and the individual physicians. This would greatly improve the quality of care with the associated drop in readmission rates.3
The public reporting of readmission rates of hospitals by the CMS is not only beneficial in policy development but helps in identifying the hospitals that are providing higher quality services than others. These can then be used as benchmarks to improve performance in the lower performing hospitals. The patient is also informed on where to receive higher quality medical attention to improve their chances of recovering.3
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