Kista R. Hamrick is the Vice President of Quality Standards for American Medical Facilities Management’s West Virginia Nursing & Rehabilitation Centers. At the beginning of 2009, the new Quality Indicator Survey (QIS) was being rolled out to nursing homes across the state of West Virginia.

“We immediately realized we needed education and new internal processes to get ahead of the survey,” says Kista. “Moreover, our past performance on the traditional survey was satisfactory but not outstanding.

The abaqis Quality Management System helped us redefine what quality assurance means to our facilities; our staff now has a renewed sense of empowerment. This new system forced us to take a hard look at ourselves and the way we treat our residents, and helped our staff prepare for the QIS survey.”

The revolutionary, industry leading abaqis Quality Assurance Program is not only a powerful marketing tool used to gain referrals and show the strengths of the facility, but also helps nursing homes track readmissions.

Research shows that roughly 18% of patients discharged from hospitals are readmitted within 30 days; one-third within 90 days. Medicare alone spends $15 billion annually on these round trips. Private insurers spend uncounted more dollars.

To address the high costs of unnecessary hospitalizations, CMS is implementing a number of provisions from the ACA. One of these is the “Hospital Readmissions Reduction Program,” which will foster smooth transitions for patients and reward hospitals that successfully reduce avoidable readmissions. Beyond improving the quality of care for Medicare beneficiaries with certain chronic conditions, the Centers for Medicare & Medicaid Services (CMS) projects that this provision, when fully implemented, will reduce Medicare costs by $8.2B over the next ten years.

Beginning in FY 2013, PPS hospitals with higher-than expected readmission rates will experience a decrease in Medicare payments.

Hospital performance will be evaluated based on the 30-day readmission measures for three diagnoses: heart attack, heart failure and pneumonia. All three are currently part of the Medicare pay-for-reporting program and reported on Hospital Compare. The ACA requires CMS to modify the measures to exclude planned readmissions as well readmissions that are transfers to another acute care facility.

CMS will calculate hospitals’ actual readmission rates and compare them to hospitals’ expected readmission rates. Those hospitals with higher than expected readmission rates will be required to pay back to the Medicare program the payments they received for those readmissions deemed to be excessive. To recoup the money, CMS will determine an adjustment factor for each hospital with excessive readmissions that will decrease the hospital’s Medicare payment rate across all discharges. There is a ceiling as to how large the reduction can be. In FY 2013, the reduction cannot be greater than 1%. In FY 2014, it cannot be larger than 2% and in FY 2015 and beyond, it cannot be greater than 3%.

According to Scott Leopold of Medline Industries Inc., America’s largest privately held national manufacturer and distributor of health care supplies and services, “Hospitals will be subject to a 1% payment penalty on their total Medicare reimbursement if they are found to be below what is deemed acceptable. As a result of this provision, hospitals will look for post acute care partners that will help coordinate better transitions in care and provide results in managing unnecessary hospital readmissions. As a provider of post-acute care, it’s important to have readmission management tools and programs in place to ensure you remain a provider of choice.”

According to Scott, “The abaqis Quality Management System is the only patented tool that has been shown to reduce the number of annual survey deficiencies. Using abaqis for your quality assurance will improve your quality of care because it highlights the Care Areas that need the most attention. And now, it can also help you reduce hospital readmissions.”

With the abaqis readmission tracker, you can:

– Develop trend analyses and track rates for readmissions

– Demonstrate to hospitals your readmission rates with real data

– Promote your facility as a superior choice for resident placement

– Use targeted reports to identify root cause of hospital readmissions to support continuous improvement

– Compare rates between facilities or groups of facilities. With abaqis, you’ll have the additional analytics you need to efficiently and proactively manage your hospital readmissions.

The net result is that your readmission data becomes a powerful marketing tool for showcasing your facility’s quality to hospitals.

Contact Scott Leopold today at 845-596-6678 or sleopold@medline.com to learn more about this important quality assurance tool.

Specials and exclusive discounts on Medline products are available through the Prime Source GPO.