Why Should You Act?

• Hospitalists, by definition, introduce discontinuity in care as patients transition from outpatient provider, to the hospital medicine service, and then back to outpatient provider.
• Care transition can lead to multiple negative consequences such as decreased patient understanding, medication errors, increased stress on the caregiver, increased readmission rates, and an increase in care costs.
• Collaboration between health care providers has been shown to improve these outcomes, as well as patient satisfaction and quality of life.
• MedPAC (Medicare Payment Advisory Committee) has recommended to Congress in its 2007 and 2008 reports major changes in how hospitals are reimbursed for hospitalizations and rehospitalizations. Such changes will justify investments to improve the hospital discharge process and potentially provide remarkable return on investment. (See below)

(Recommended) changes in Medicare payment for care provided around a hospitalization to encourage care coordination and efficiency:

• First, that the Secretary confidentially report to hospitals and physicians information about resource use around a hospitalization (e.g., the inpatient stay plus 30 days postdischarge) and readmission rates. After two years of confidential disclosure to providers, this information should be reported publicly.

• Second, reducing payments to hospitals with relatively high readmission rates for select conditions. This payment change should be made together with a change in law, which MedPAC recommended previously, to allow hospitals and physicians to share in the savings that result from providing care more efficiently. (In contrast, the current payment system rewards increasing the volume of medical services, not improving efficiency. The report discusses how hospitals and physicians in some cases have responded with financial and organizational arrangements that encourage volume growth.)