Interventions as an alternative to penalties in preventable readmissions

Abstract

While expenditures in healthcare in the United States are the highest in the world, it is widely known that those resources are not being used efficiently. The government addressed this situation in the Patient Protection and Affordable Care Act, in an attempt to improve quality and affordability of healthcare. In the fiscal year 2013, the Centers for Medicare and Medicaid Services began imposing financial penalties through the Inpatient Prospective Payment System to hospitals that have higher than expected readmission rates for specific diseases. The nature and effects of this new policy have raised several concerns. This article discusses Medicare’s hospital readmissions reduction program and presents an alternate policy based on diseasespecific interventions to reduce preventable readmissions. Our results show that a policy based on implementing disease-specific interventions, instead of penalties, may save 33.43% of hospitals from being under the penalization level in the first year, while at the same time improving the delivery of care.