Series 1 Paper 2

In 2014, it was projected that some of Medicare’s Pioneer ACOs would transition from a shared savings/shared loss model to a completely “population-based payment.”[1]

This means they would bear the full brunt of the cost of an unnecessary readmission, not just a percentage. [2]

Each of the 22 systems shown in this graphic want to ultimately do two things: 1) Provide a correct diagnosis and 2) Offer an appropriate plan of care for the patient to follow.  Historically, we have been pretty good at accomplishing these two tasks.  On the other hand, adherence or patients reaching up and taking our advice, has at best, been a 50/50 proposition.  As time passes post diagnosis, the persistence rate often drops below 30%.  Correlation is not causation, but it is curious that there is a higher incidence of unscheduled readmissions for non-adherent patients than adherent patients.

A significant part of today's literature focuses on describing how coordinating, collaborating, and communicating within and between our organizations and practices can improve outcomes related to hospital readmissions. There is also the increasing reality that providers are held financially accountable for the outcomes of their patients, even after they have been discharged.  Sufficient evidence exists in the CMS literature to support the reality that providers will be held jointly accountable for patient outcomes.  In the world of Respondeat Superior, that means ultimately the providers will be 100% accountable.  Coordinating, collaborating, and communicating with patients will take on an altogether different meaning as time passes.

In this paper, we explore why the missing part of the Coordinating, Collaborating, and Communicating argument is Consequences.

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[1] Center for Medicare and Medicaid Innovation, “Pioneer Accountable Care Organization Model: General Fact Sheet,” Centers for Medicare and Medicaid Services, updated September 12, 2012, page 4, Baltimore.  http://innovations.cms.gov/Files/fact-sheet/Pioneer-ACO-General-Fact-Sheet.pdf

[2] Jordan Rau, “Medicare to penalize 2,217 hospitals for excess readmissions,” Kaiser Health News, August 13, 2012. http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx

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