"The inclusion of the Hospital Readmission Reduction Program (HRRP) in the Affordable Care Act represents a movement toward high powered incentives to reduce hospital readmission. This has spurred a concomitant rise in research interest on this topic (Kangovi and Grande, 2011; Joynt and Jha, 2013; Williams, 2013). "
[Show abstract][Hide abstract] ABSTRACT: All-cause readmission to inpatient care is of wide policy interest in the United States and a number of other countries (Centers for Medicare and Medicaid Services, in the United Kingdom by the National Centre for Health Outcomes Development, and in Australia by the Australian Institute of Health and Welfare). Contemporary policy efforts, including high powered incentives embedded in the current US Hospital Readmission Reduction Program, and the organizationally complex interventions derived in anticipation of this policy, have been touted based on potential cost savings. Strong incentives and resulting interventions may not enjoy the support of a strong theoretical model or the empirical research base that are typical of strong incentive schemes. We examine the historical broad literature on the issue, lay out a 'full' conceptual organizational model of patient transitions as they relate to the hospital, and discuss the strengths and weaknesses of previous and proposed policies. We use this to set out a research and policy agenda on this critical issue rather than attempt to conduct a comprehensive structured literature review. We assert that researchers and policy makers should consider more fundamental societal issues related to health, social support and health literacy if progress is going to be made in reducing readmissions.
Health Economics Policy and Law 08/2013; 9(2):1-21. DOI:10.1017/S1744133113000340 · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Unplanned follow-up care is the focus of intense health policy interest, as evidenced by recent financial penalties imposed under the Affordable Care Act. To date, however, unplanned post-surgical care remains poorly characterized, particularly for patients with kidney stones. Our objective was to describe the frequency, variation and financial impact of unplanned, high–acuity, follow-up visits in the treatment of patients with urinary stone disease.
We identified privately insured patients undergoing percutaneous nephrostolithotomy, ureteroscopy, or shock wave lithotripsy for stone disease. The primary outcome was occurrence of an emergency department visit or hospital admission within 30 days of the procedure. Multivariable models estimated the odds of an unplanned visit and the incremental cost of those visits, controlling for important covariates.
We identified 93,523 initial procedures to fragment or remove stones. Overall, 1 in 7 patients had an unplanned post-procedural visit. Unplanned visits were least common following shock wave lithotripsy (12%), and occurred with similar frequency after ureteroscopy and percutaneous nephrostolithotomy (15%). Procedures at high-volume facilities were substantially less likely to result in an unplanned visit (OR 0.80, 95% CI 0.74–0.87, P<0.001). When an unplanned visit occurred, adjusted incremental expenditures per episode were greater after shock wave lithotripsy [$32,156 (95% CI $30,453–33,859)] than after ureteroscopy [$23,436 (95% CI $22,281–24,590)].
Patients not infrequently experience an unplanned, high-acuity visit after low-risk procedures to remove urinary stones, and the cost of these encounters is substantial. Interventions are indicated to identify and reduce preventable unplanned visits.
Surgery 01/2013; 155(5). DOI:10.1016/j.surg.2013.12.013 · 3.11 Impact Factor
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