Healthcare Statistics And Research

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MSBP and Hospital Readmission Rates

Your Name (First M. Last)

School or Institution Name (University at Place or Town, State)

MSBP and Hospital Readmission Rates

Foreword

It is my honor to present my findings to the CEO and executive leadership of Choice Hospital regarding Medicare reimbursement initiatives on Medicare spending per beneficiary (MSPS) and hospital admission rates. I have worked in collaboration with the chief financial officer and his team to prepare the following report.

MSBP

The Medicare Spending per Beneficiary (MSPB) evaluates the cost of Medicare services provided by a clinician in MSPB period that includes the time instantly before, in between, and after the stay in hospital (Simon et al., 2018). The MSPB event comprises all Medicare Part A, and Part B claims that fall in the event window, particularly claims with a beginning date in 3 days before admission to hospital (which is also called the index admission) over the period of 30 days following hospital discharge.

Moreover, the MSPB measure is characterized by individual clinicians, recognized by the distinct Medicare Taxpayer Identification Number. MSPB performance can be reported at the clinician or the clinician group stage.  Hospital Readmission Rates

Hospital readmission is defined as any unintentional admittance to hospital in the 30 days after discharge irrespective of the reasons for new admission, and even the admission is not related to the original reason. It is a penalty program but not for the hospitals that have ERR less than or equal to 1. However, for the hospitals with ERRS more than, they will be penalized. The penalties are capped at 3 of the hospitals reimbursement by CMS for Medicare patient admission. In this regard, 1.8 of hospitals had been penalized at the rate of 3 (Hospital Readmissions Reduction Program (HRRP) - NEJM Catalyst, 2018). The rate of penalty is levied for every Medicare admission of the hospital for the following year. According to the feedback, hospitals with a high percentage of patients with low-income are unjustly penalized.

The Post-Acute Care Transformation Act of 2014 enabled Medicare program or initiative to use the statistics. The Medicare and CMS are in contract with Acumen, LLC to make MSPBAC standards according to the Calculating Event-Based costs from the Medicare Episode Grouper for Physician Response contract (cms.gov). Post-Acute Care services focus on measurement of resources in the PAC settings. From the year 2001 to 2013, the overall spending of Medicare PAC increased at 6.1 annually and doubled to 59.4 billion. On the other hand, the payment to inpatients increased at 1.7 annually during this particular period.

Overall, 3.241 hospitals were assessed according to the hospital readmissions reduction program in the year 2018. Out of these hospitals, 2.573 will be penalized for inpatients stays takings place from October 201 to September 2018. In this context, it demonstrates a cut as far as reimbursement is concerned for hospitals of 654 million, increased from the figure of 528 million in the year 2017 (Hospital Readmissions Reduction Program (HRRP) - NEJM Catalyst, 2018). Last year in January, the Medicare Payment Advisory Commission (MedPAC) experts came with the conclusion of the research about Hospitals Readmission Reduction Program (HRRP). Their findings indicate that the risk adjusted and raw readmission percentage decreased for terms under HRRP.

In addition, earlier researches also recorded improvements. The study by the Obama administration indicated that readmissions for target-based conditions declined from 21.5 to 17.8 between 2007 and 2015. Besides, readmissions for target-based conditions declined considerably more at hospitals that were related to the Hospital Readmission Reductions Program as compared to those that were not. Also, the readmission for the conditions under HRRP was minimized more than the conditions that are not covered by HRRP. According to this data, HRRP played a role to reduce readmissions. However, the legislation, recording, and evaluating something so complicated is never an easy task, and of course, the plan is implemented with a lot of questions, concerns, and criticisms.

References

Hospital Readmissions Reduction Program (HRRP) - NEJM Catalyst. (2018). Retrieved from HYPERLINK https//catalyst.nejm.org/hospital-readmissions-reduction-program-hrrp/ https//catalyst.nejm.org/hospital-readmissions-reduction-program-hrrp/

CMS. Gov. HYPERLINK https//www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/2016_07_20_mspb_pac_ltch_irf_snf_measure_spe https//www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/2016_07_20_mspb_pac_ltch_irf_snf_measure_spe

Samson, L. W., Chen, L. M., Epstein, A. M., Maddox, K. E. J. (2018). Dually enrolled beneficiaries have higher episode costs on the Medicare spending per beneficiary measure. Health Affairs, 37(1), 86-94.

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HEALTHCARE STATISTICS AND RESEARCH

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