CMS More Closely Aligns Hospital and Home Health Incentives with New Readmission Calculation

By Barbara Rosenblum
January 21, 2014 Home Health

In its ongoing focus to reduce hospital readmissions, CMS is introducing a new means for calculating the 30-day re-admission metric.We think the new measure is more favorable to home health and strikes a nice balance between emulating the hospital measure and giving agencies an accurate evaluation of their performance. This new approach lays the groundwork for developing improvement plans ahead of the 2015 Home Health Compare publication.

SHP and CMS are in lockstep on this measure. In fact, we’ve been reporting 30-day readmissions using similar logic for more than a year, recognizing the need to provide data that closely approximates the Hospital-Wide All-Cause Unplanned Readmission Measure (NQF #1789).

Case in point: In a recent article in Home Health Line (December 9, 2013 issue; pages 3-4), SHP client Brookdale Senior Living Solutions reported that they began tracking 30-day rehospitalization rates about a year ago. Using alerts from SHP and HCHB to identify high-risk patients and implementing appropriate plan of care strategies, Brookdale reduced its rate of rehospitalization within 30 days of home health admission from 15.25 percent in January 2013 to 13.32 percent in October 2013.

Without getting too technical, CMS’s logic uses M0030 as the 30-day start or index point. To deal with the fact that a hospital discharge could precede the home health start of care date by up to 14 days, CMS caps that window of time at a maximum of five days. That is, M1005 cannot be more than five days prior to M0030 for the patient to be included in the measure denominator. This means it will include some patients who had a greater than 30-day span between hospital discharge and hospital readmission.

So, while being slightly out of line with the hospital measure, it does reframe the data in a context more under the control of the home health agency. Agencies are not held accountable for rehospitalization in cases where more than five days elapsed between initial inpatient facility discharge and the start of home health.

In the 2014 Final Rule, CMS mentions home health services as a means for hospitals to prevent readmissions. Agencies are encouraged to share their SHP reports with hospitals to demonstrate low or improved readmission rates. The reports include breakouts by the diagnosis groups impacting hospital revenue now (AMI, heart failure, pneumonia) and those that will impact rates starting in 2015 (joint replacement and COPD).

Look for enhanced SHP rehospitalization reports in January 2014. You’ll see we’ve applied the new CMS measure logic with the breakouts by revenue impact diagnosis groups and some additional drill-down capability.