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Hospitalists? Post-Acute Care Utilization Is Rising, Resulting in Rapidly Increasing Costs

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Hospitalists? Post-Acute Care Utilization Is Rising, Resulting in Rapidly Increasing Costs ANALYSIS KEY CLINICAL QUESTION IN THE LITERATURE Post-acute care: Transfusing ppatientsatients Prescribe antibiotics LTC quality report cards with aanemianemia wisely PAGE 16 PAGE 28 PAGE 40 VOLUME 21 NO. 12 I DECEMBER 2017 AN OFFICIAL PUBLICATION OF THE SOCIETY OF HOSPITAL MEDICINE How will SNF readmissions penalties affect hospitalists? Post-acute care utilization is rising, resulting in rapidly increasing costs By Larry Beresford tarting in 2018, skilled nurs- Sing facilities (SNFs), like acute care hospitals before them, will be subject to a penalty of up to 2% of their Medicare reimbursement for posting higher-than-average rates of readmissions. Managing mental health The Protecting Access to Medi- care Act of 2014 established a value- based purchasing component for SNFs, including incentives for high- care at the hospital performing facilities and a measure for all-cause, all-condition readmis- sions to any hospital from the SNF Care integration is more of an attitude than a system within 30 days following hospital discharge – designed to recognize By Suzanne Bopp shrinking resources are the other. Mental health resources had and reward, or punish, facilities’ already been diminishing for decades before the recession hit – performance on preventing unnec- he numbers tell a grim story. Nationwide, 43.7 million and hit them especially hard. Between 2009 and 2012, states essary readmissions. Public report- T adult Americans experienced a mental health condition cut $5 billion in mental health services; during that time, at ing of SNF quality data, including during 2016 – an increase of 1.2 million over the previ- least 4,500 public psychiatric hospital beds nationwide disap- readmission rates, started in October ous year. Mental health issues send almost 5.5 million people peared – nearly 10% of the total supply. The bulk of those 2017. Penalties follow a year later. to emergency departments each year; nearly 60% of adults resources have never been restored. Some patients’ readmissions could with a mental illness received no treatment at all. Provider numbers also are falling. “Psychiatry is prob- trigger penalties for both the hospi- If that massive – and growing – need is one side of the story, CONTINUED ON PAGE 25 tal and the SNF. According to 2010 data, 23.5% of patients discharged from acute care hospitals to SNFs were readmitted to the hospital within 30 days, at a finan- cial cost of $10,362 per readmission A LOVE OF or $4.34 billion per year.1 Seventy Q&A eight percent of these readmissions TEACHING were labeled avoidable. More recent evidence suggests that hospitalization rates for dual-eligible patients living in James Kim, MD long-term care facilities decreased by P. 13 31% between 2010 and 2015.2 As increasing numbers of hospitalists Plainview, NY 11803-1709 NY Plainview, Lebanon Jct. KY Jct. Lebanon spend some or all of their work week in Permit No. 384 No. Permit Suite 2, 2, Suite PAID post-acute care settings, how will the 151 Fairchild Ave., Ave., Fairchild 151 U.S. Postage U.S. Presorted Standard Standard Presorted SNF readmission penalty affect their THE HOSPITALIST HOSPITALIST THE CHANGE SERVICE REQUESTED SERVICE CHANGE CONTINUED ON PAGE 18 SOCIETY PAGES I News and information about SHM Building a better SHM Volume 21 Number 12 December 2017 PHYSICIAN EDITOR THE SOCIETY OF HOSPITAL MEDICINE Danielle B. Scheurer, MD, SFHM, MSCR Phone: 800-843-3360 New HMX platform and website are highlights [email protected] Fax: 267-702-2690 Website: www.HospitalMedicine.org PEDIATRIC EDITOR By Brett Radler SHM emails, we urge you to opt back in Weijen Chang, MD, FAAP, SFHM Laurence Wellikson, MD, MHM, CEO [email protected] Lisa Zoks to receive information on your local chap- Vice President of Marketing & COORDINATING EDITORS s we enter the holiday season, the ter meetings and more targeted messages Communications Society of Hospital Medicine is about SHM offerings tailored specifically Christine Donahue, MD [email protected] A THE FUTURE HOSPITALIST preparing to unwrap a refreshed to your interests. Jonathan Pell, MD Brett Radler experience for all members and partners. • The SHM website, www.hospitalmedi- KEY CLINICAL GUIDELINES Marketing Communications Manager [email protected] Next month, SHM will launch its new cine.org, will be optimized for your CONTRIBUTING WRITERS association management system (AMS), smartphone and tablet and have a fresh Felicia Steele Mel L. Anderson, MD, FACP; Vineet Marketing Communications Specialist its new online community platform for the look and feel on all devices, complete with Arora, MD, MPH, MHM; Larry Beresford; [email protected] Hospital Medicine Exchange (HMX), and a new, intuitive navigation and streamlined Rebecca Berger, MD; Suzanne Bopp; Andrew D. Bowser; Doug Brunk; Thomas brand new website to better serve the needs content – making it easier for you to find SHM BOARD OF DIRECTORS R. Collins; Kevin Conrad, MD; Randy Ron Greeno, MD, FCCP, MHM of its constituents. the information that is the most relevant Dotinga; Lucas Franki; Denise Fulton; President While many may be unaware of the for you in even less time. Alicia Gallegos; Charlene Harrington, Nasim Afsar, MD, SFHM systems and platforms SHM currently uses, • The Hospital Medicine Exchange (HMX) PhD, RN; Matthew Hoegh, MD; Samuel President-Elect F. Hohmann, PhD, MS-HSM; Amy Karon; an AMS is essentially SHM’s EHR for its will move to an intuitive new platform Christopher Frost, MD, SFHM Bryan Lublin, MD, MPH; Farrin A. Manian, Treasurer members. It houses each member’s infor- to enhance your online discussions and MD, MPH; Matthew Modes, MD, MPH; Howard R. Epstein, MD, SFHM mation, so the more information SHM has, group collaborations, including chapters, Jeffrey Newman, MD, MPH; M. Alexander Secretary the more SHM can customize the types of interest groups, committees, and more. Otto; Micah T. Prochaska, MD, MS; Leslie Brian Harte, MD, SFHM Ross, PhD; Hemal N. Sampat, MD; Larry information you receive. All systems will be Immediate Past President Sharp, MD, SFHM; Joseph A. Simonetti, Tracy Cardin, ACNP-BC, SFHM integrated so you can quickly access infor- In addition to these technological MD, MPH; Sarah A. Stella, MD, FHM; Sam Jeffrey J. 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