A CMS pilot program aimed at leveraging community-based health care successfully lowered 30-day readmission rates and all-cause hospitalizations among Medicare beneficiaries over a two-year period, according to a study published Wednesday in the Journal of the American Medical Association, Kaiser Health News' "Capsules" reports.
Study Details
For the project, health care providers, social service workers and other community members established flexible quality improvement organizations in 14 economically and demographically diverse communities (Rao, "Capsules," Kaiser Health News, 1/22).
The researchers compared their performance with 50 communities without QIOs before the community-based interventions were implemented -- between 2006 and 2008 -- and when implementation was in progress -- between 2009 and 2010 (McKinney, Modern Healthcare, 1/22).
Study Findings
The study found that 30-day hospital readmission rates declined by 5.7% over a two-year period ("Capsules," Kaiser Health News, 1/22). Specifically, mean 30-day readmission rates per 1,000 beneficiaries fell from 15.21 in 2006 through 2008 to 14.43 in 2009 and 2010, while rates in the 50 comparison communities declined from 15.03 to 14.72 during the same periods (Modern Healthcare, 1/22).
The researchers noted that community-based transition care prevented 1,800 readmissions over 18 months, as well as an additional 6,800 new hospital admissions among those beneficiaries after 30 days (Booth, Denver Post, 1/22).
Meanwhile, community-based transition care also reduced all-cause hospitalizations by an average of 5.74%, compared with a 3.17% average decrease in the 50 comparison communities (Modern Healthcare, 1/23).
Overall, the researchers wrote that in an average community with 50,000 beneficiaries, Medicare could save $4 million annually on hospital readmission costs for every $1 million spent on community-based interventions.
Study co-authors Jane Brock -- a coordinator at the Colorado Foundation for Medical Care's Medicare QIO -- and Joanne Lynn -- a director at the Altarum Institute's Center for Elder Care and Advanced Illness -- noted that unlike most research projects, which maintain the same set of evidence-based practices and protocols throughout the study period, the pilot communities were able to modify their programs as they worked to meet their specific community needs (Kenen, Politico, 1/23).
Proportion of Hospital Readmissions Remains Steady
Despite the declines, the researchers noted that there was no change in the rate of 30-day readmissions as a percentage of hospital discharges (Modern Healthcare, 1/22). Lynn said that the proportion of readmissions remained the same because the program lowered both 30-day readmissions and Medicare hospital visits.
According to Politico, this could pose a problem for quality and incentive programs that are based specifically on measuring readmission rates, such as those being implemented under the Affordable Care Act (Politico, 1/23).