Health care reform bill focuses on readmissions

The Patient Protection and Affordable Care Act (H.R. 3590) puts considerable focus on reducing hospital readmissions. Here are some excerpts and key provisions from the bill on this subject:

• By 2012, the Secretary of the Department of Health and Human Services (HHS) will develop reporting requirements for use by health plans to improve health outcomes and "implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post-discharge reinforcement by an appropriate health care professional."

• Under Part II on consumer choices and insurance competition through health benefit exchanges (section 3590-55), there is a section on rewarding quality through market-based incentives. One of the strategies mentioned involves "the implementation of activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post-discharge reinforcement by an appropriate health care professional."

• Under section 2703, which discusses a state option to provide medical homes for enrollees with chronic conditions, there is a monitoring provision which describes "a methodology for tracking avoidable hospital readmissions and calculating savings that result from improved chronic care coordination and management under this section; and (2) a proposal for use of health information technology in providing medical home services under this section and improving service delivery and coordination across the care continuum (including the use of wireless patient technology to improve coordination and management of care and patient adherence to recommendations made by their provider).

• In section 3023, which features the national pilot program on payment bundling, there are quality measures established that include the following: "(i) Functional status improvement; (ii) Reducing rates of avoidable hospital readmissions; (iii) Rates of discharge to the community; (iv) Rates of admission to an emergency room after a hospitalization; (v) Incidence of health care-acquired infections; (vi) Efficiency measures; (vii) Measures of patient-centeredness of care; (viii) Measures of patient perception of care; (ix) Other measures, including measures of patient outcomes, determined appropriate by the secretary."

• The independence-at-home demonstration program (section 3024) makes a requirement of testing the model for accountability with these quality measures: "(A) reducing preventable hospitalizations; (B) preventing hospital readmissions; (C) reducing emergency room visits; (D) improving health outcomes commensurate with the beneficiaries' stage of chronic illness; (E) improving the efficiency of care, such as by reducing duplicative diagnostic and laboratory tests; (F) reducing the cost of health care services covered under this title; and (G) achieving beneficiary and family caregiver satisfaction."