What is the duty of the provider after the diagnosis or discharge?

It all started, when...

According to the Centers for Medicare and Medicaid (CMS), transitional care is a joint responsibility.  However, “joint” was defined by CMS in a sentence, “Improving readmission rates is the joint responsibility of hospitals and clinicians.”  

A 2008 CMS contracted report[1] went on to add, “Measuring readmission will create incentives to invest in interventions to improve hospital care, better assess the readiness of patients for discharge and facilitate transitions to outpatient status.”   In a universe that strongly supports the notion of “patient centeredness,”  it appears the patient was left out of the equation and the focus of preventing unplanned readmissions fell squarely on hospitals and community based providers.

In Appendix 5 of this report to CMS, Krumholz, et. al. described 189 contributing conditions (CC) with potential complications to the index admission.  What is not discussed, or even mentioned, is the patient’s responsibility to follow their plan of care and specifically take medications as prescribed. The words “adherence” and/or “nonadherence” were nowhere to be found in this research article.  It appears the focus was to see where failure to treat, educate, and transition patients properly, contributed to unplanned readmissions.  The idea that patients contribute to their own readmission, through choosing to not follow their plan of care, was not even considered in this seminal research.  

Many of the penalty elements in the 2010 Affordable Care Act and now, MACRA and MIPS, were based on this document.  However, the CMS system is hurling over itself at improving hospital and provider quality without considering the impact the patient's behavior has on outcomes.

In a series called, "What MIPS can do for you?", we will look at several of the Clinical Practice Improvement Activities (cp_IA) that CMS will be monitoring in both primary practice and hospital settings. Providers will see the over 200+ Quality Payments (QP), and 94+ Improvement Activities (cp_IA).

[1] Krumholz, H, et al, 2008, Hospital 30-Day Heart Failure Readmission Methodology, Harvard Medical School, Department of Health Policy. Download full text here: Baseline info on Readmissions: Krumholz

 

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