New Federal Guidance on Reducing Medicaid Hospital Readmissions

25 August 2014 Health Care Law Today Blog

The Agency for Healthcare Research and Quality (AHRQ) recently issued a guide to assist hospitals in reducing Medicaid patient readmissions. The AHRQ Hospital Guide to Reducing Medicaid Readmissions is the product of a two-year study which focused on identifying evidence-based strategies to reduce hospital readmissions and better serve the transitional care needs of the adult Medicaid population. According to AHRQ, the guide is the only federal tool that is specifically tailored to reducing readmissions in the adult Medicaid population.

Reducing hospital readmissions is a national priority for payers, providers, and policymakers. Over the past several years, the Centers for Medicare & Medicaid Services and the Center for Medicare & Medicaid Innovation have created various incentive programs, instituted financial penalties, and provided technical assistance to providers and communities with the goal of reducing hospital readmissions. The majority of these programs focus on the Medicare fee-for-service population, and use geriatric health service literature as the basis for the programs.

As a result of these federal programs, many hospital readmission reduction initiatives target Medicare beneficiaries. However, Medicaid readmission rates can be equally problematic for hospitals. According to a number of AHRQ’s Healthcare Cost and Utilization Project studies, the adult, non-obstetric Medicaid population has readmission rates as high or higher than the Medicare fee-for-service population, with readmission rates for adult Medicaid patients ages 24-64 up to 24% in some cases. Given the clinical and sociological differences between the Medicare and Medicaid populations, the transitional care strategies that are effective for Medicare patients need to be modified to better meet the post-hospital needs of adult Medicaid patients.

The AHRQ guidance document is intended to assist hospitals with adapting the Medicare readmission reduction best practices in order to reduce Medicaid readmission rates. The guide is designed to help hospitals in all stages of readmission reduction initiatives identify ways to adapt or expand their existing Medicaid population efforts, by using a two-step process. The first step involves analyzing the various causes of readmissions, assessing the hospital’s current readmission reduction efforts, and examining the extent to which the current efforts meet the needs of adult Medicaid patients. The second step involves implementing strategies to improve the hospital-based process to better target and serve Medicaid patients’ needs, expanding and strengthening Medicaid-specific cross-setting partnerships, and providing enhanced services to patients at high-risk for readmission. The guide also includes a number of insightful examples from hospitals around the country that have successfully implemented the recommended practices.

In addition to the guidance document, AHRQ provided a set of customizable toolkits. The toolkits are designed to be used in conjunction with the guide, and should enable hospitals to adapt existing best practices to the hospital’s Medicaid population. AHRQ also included new tools that were developed as part of the project.

Hospitals will soon face additional pressure to reduce Medicaid readmission rates as policymakers and payers focus on the unique needs of newly enrolled and dually eligible Medicaid patients at the state and federal levels. Hospitals will need to ensure that they have effective transition and post-hospital support services in place in order to achieve the cost and quality objectives of the Medicaid program.

Originally, this article was an alert sent to the American Health Lawyers Association’s (AHLA) Regulation, Accreditation and Payment Practice Group. For more information, visit AHLA’s website.

This blog is made available by Foley & Lardner LLP (“Foley” or “the Firm”) for informational purposes only. It is not meant to convey the Firm’s legal position on behalf of any client, nor is it intended to convey specific legal advice. Any opinions expressed in this article do not necessarily reflect the views of Foley & Lardner LLP, its partners, or its clients. Accordingly, do not act upon this information without seeking counsel from a licensed attorney. This blog is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Communicating with Foley through this website by email, blog post, or otherwise, does not create an attorney-client relationship for any legal matter. Therefore, any communication or material you transmit to Foley through this blog, whether by email, blog post or any other manner, will not be treated as confidential or proprietary. The information on this blog is published “AS IS” and is not guaranteed to be complete, accurate, and or up-to-date. Foley makes no representations or warranties of any kind, express or implied, as to the operation or content of the site. Foley expressly disclaims all other guarantees, warranties, conditions and representations of any kind, either express or implied, whether arising under any statute, law, commercial use or otherwise, including implied warranties of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Foley or any of its partners, officers, employees, agents or affiliates be liable, directly or indirectly, under any theory of law (contract, tort, negligence or otherwise), to you or anyone else, for any claims, losses or damages, direct, indirect special, incidental, punitive or consequential, resulting from or occasioned by the creation, use of or reliance on this site (including information and other content) or any third party websites or the information, resources or material accessed through any such websites. In some jurisdictions, the contents of this blog may be considered Attorney Advertising. If applicable, please note that prior results do not guarantee a similar outcome. Photographs are for dramatization purposes only and may include models. Likenesses do not necessarily imply current client, partnership or employee status.

Related Services