Coming reimbursement changes for hospital performance

Posted on May 8, 2012


If you have not heard about the changes coming in Medicare reimbursements to hospitals.  The changes are significant and could severely impact hospitals that do not demonstrate the delivery of quality care to their patients.  Hospitals are concerned, and  they should be but these changes should positively impact the patients experience both in the hospital and after discharge.

Value-based purchasing (VBP)

In October of 2012 Medicare will launch the hospital VBP program, in which pay-for-performance programs will receive incentives for demonstrated excellence and improvements in patient safety and effective care.  Under this program Medicare will reward hospitals that provide high quality care for their patients through the new Hospital Value-Based Purchasing (Hospital VPB) program.  For the first time, hospitals across the country will be paid for inpatient acute care services based on care quality, not just the quantity of the services they provide.


Under the Affordable Care Act provision, hospitals will face penalties for excess readmissions for heart attack, heart failure and pneumonia, starting in October.  CMS did account for planned readmissions from heart surgeries following a heart attack at the request of the AHA.  For hospitals that experience readmission rates higher than the norm the penalties will reduce the entire Medicare dollars paid to them starting at 1% in 2013 and accelerating to 2% in 2014 and 3$ in 2015.  Although only people with 3 diagnosis, heart attack, heart failure and pneumonia, will be monitored for 2013 it is important to repeat that the penalty will be 1% of the entire Medicare reimbursement.   In FY 2015, the policy expands to include COPD, CABG, PTCA and Other Vascular diseases.   In addition, hospitals will be required to submit the appropriate information for CMS to calculate hospital specific all-payer readmission rates, which would be publicly reported on Hospital Compare.

Payment Adjustment for Hospital Acquired Conditions

Beginning in 2015, hospitals scoring in the top quartile for the rate of Hospital Acquired Conditions (HAC) as compared to the national average will have their Medicare payments reduced by 1 percent for all diagnosis groups.

In response to this, BrightStar developed BrightStar Clinical Pathways℠ and the Hospital Accelerated Nurse Discharge Service (HANDS)

HANDS is designed to provide patients with a save transition from the hospital into the home.  We can pick you up at the hospital, transport you home, our Registered Nurse can ensure you have your new medications and that they are integrated into your regimen.  If you need a special diet we can do some shopping.  We can ensure the home is safe from trip and fall hazards and provide any other assistance you may need during the first 24 hours in your home.

The BrightStar Clinical Pathways℠ are evidence based, condition specific, time-based plan to:

  • Reduce costs for hospitals that need to reduce readmission rates
  • Increase patient satisfaction so that hospitals can avoid Medicare penalties

Only BrightStar Care can deliver this revolutionary care program that empowers and educates individuals with chronic illness like heart failure, Chronic Obstructive Pulmonary Disease (COPD), and Pneumonia to avoid stressful and costly return trips to the hospital. This evidence-based program combines RN oversight, Joint Commission Accreditation, and our CareTogether technology to provide superior patient care.

BrightStar Clinical Pathways employ BrightStar’s clinical expertise

BrightStar Clinical Pathways is an RN-coordinated, team-oriented, and evidence-based approach to optimize client health and well being and reduce the likelihood of a return trip to the hospital. BrightStar Clinical Pathways is an evidence-based program inspired by national recognized care transition programs, like The Coleman Care Transitions Intervention Program that resulted in a 50% reduction in readmissions after 30 days. Patients in the Coleman clinical trial were more likely to achieve self-identified personal goals for symptom management.

BrightStar is uniquely qualified to provide this level of comprehensive care thanks to having an RN in every office.

The RN Clinical Pathways Coordinator plays an active role in each Clinical Pathway case by both visiting the client regularly and making sure every CNA or HHA who works on a Pathway case is specially trained in that condition.

BrightStar Care of Downtown Houston

Need help? Every day, more American families take on the responsibilities of caring for a loved one in need of physical, social, emotional, or financial assistance. Despite the craziness of life, sons, daughters, brothers, and sisters make the time to prepare meals, provide transportation, do laundry, run errands, and more. BrightStar is an in-home health care company designed to help, give us a call at 832-730-1255.