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2012 Potpourri I

By January 6, 2012Commentary

What to do about hospital readmissions?  Everyone is struggling with that given new penalties in effect this year.  A new study published in the Journal of Hospital Medicine suggests that adding a nurse practitioner to a medical team to help with the discharge process would result in more rapid production of discharge summaries and in more scheduling of and attendance at followup appointments, as well as increasing patient and provider satisfaction with the discharge process, but make no difference in 30-day readmission rates or ER visits.  (Hosp. J. Article)

The Centers for Medicare and Medicaid Services is beginning a new demonstration called the Independence at Home demo.  It will cover up to 50 medical practices and 10,000 beneficiaries for a three year period.  The beneficiaries must be living at home, but need help with activities of daily living and have multiple chronic diseases.  The medical practices will attempt to provide all primary care at the beneficiaries’ homes, including having home visits from physicians and nurse practitioners.  The demonstration will test whether health outcomes and patient and provider satisfaction improve and whether costs are lowered, in which case the providers may receive incentive payments.   (CMS Demo)

The University of  Wisconsin School of Medicine looked at the adequacy of discharge reports provided by hospitals to nursing homes and the effects of inadequate reports.  According to the study, these reports very often lacked needed data on diet, activity level, therapy and pending lab tests.  In some cases reports weren’t made available to the nursing home until more than 30 days after discharge.  The later the report was, the more likely the information was to be incomplete or of poor quality.  This lack of data causes extra work for nursing home staff and obviously risks poor care for patients.   (U. Wisc. Study)

Preqin, an investment information firm, indicates that private equity fund raising was difficult in the second half of 2011.  Subject to final figures which may raise the totals by a few billion, about $55 billion was raised in each of the third and fourth quarters, down from about $88 billion in the second quarter.  The total for the year was around $262 billion and should end up flat or slightly down from 2010.  Buyout funds are raising the most capital and venture funds are the most numerous.  The length of time conducting fund-raising fell from 18.7 months in 2010 to 16.5 in 2011.  Currently about 1800 funds are seeking an aggregate $740 billion.   (Preqin Release) 


In the latest iteration of its performance reporting and value-based purchasing initiatives, the Centers for Medicare and Medicaid Services released its final set of quality measures for Medicaid programs.  The measures are designed for voluntary use by state Medicaid programs, providers and managed care companies under contract with Medicaid programs.  The measures cover four areas:  adult health; maternal/reproductive health; complex health care needs and mental health and substance use.  In the end, 26 measures were recommended, with a balance of importance and validity and the burden of reporting used to determine which were selected.   (CMS Rule) 

The state of North Carolina believes that use of a medical home model saved it almost a billion dollars of Medicaid spending over four years, according to an article in Stateline Health News.  Milliman conducted the study, so it has a fair amount of credibility.  Apparently the 1.1 million enrollees covered by the program also received higher quality care.  The medical homes were paid a monthly fee to manage and coordinate patients’ care and some were eligible for bonuses based on quality of care.  In the early years of a Medicaid enrollee’s use of the program, costs might actually rise as doctor visits increased and untreated conditions were identified.  But in the long run, hospitalizations, ER use and other utilization declined.   (Stateline Article)

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