Feds push hospitals to improve care after discharging minority patients

Federal officials are urging hospitals to improve care for minority and low-income Medicare patients so they don't wind up back in the hospital soon after they're discharged.

The Centers for Medicare and Medicaid Services is issuing guidance to hospitals Tuesday on how to improve communication and care for these disadvantaged patients if they want to avoid penalties when these people have to be readmitted within 30 days of discharge.

Hospitals in poor communities have been pushing CMS to treat them differently than those that treat patients with higher income and education levels. Many minority and other low income patients are less likely to adhere to instructions after they are released, research shows.

The Affordable Care Act required hospitals to pay readmission penalties for conditions including heart attack, pneumonia and hip and knee replacements. The penalties started at 1% of Medicare reimbursements in 2013 and rose to 3% in 2015.

The issue of whether hospitals that treat a high minority population should get special treatment when it comes to quality rankings or penalties has been vexing policymakers for years.

CMS has maintained that some hospitals with large minority and low income populations have performed as well on quality rankings as others in more affluent communities.

If health care quality improvement is the target, CMS has "to focus on populations experiencing the greatest burden," says Cara James, director of CMS' Office of Minority Heath. "Otherwise we won’t achieve the goals we’re ultimately working towards."

It can be done, says Leah Binder, CEO of Leapfrog Group, which represents employers working to lower health costs and rates hospitals.

"Hospitals that care for patients inside and outside their doors lower their readmission rates and improve the health of their patients.  As the CMS report shows, this is not easy. Caring for patients...means knowing and understanding patients and communities with much greater depth and sensitivity than is traditional today."

Harlem Hospital Center in New York City is a public hospital that received Leapfrog's Top Hospital designation, because they get excellent scores in quality and safety, and they are above average on readmissions, Binder says.  is simply old-fashioned to think that health care must be centered in the four walls of a hospital. Nowadays we think health care must be centered in the lives of patients—not only within the hospital, but outside the hospital, in communities, physician offices, and homes.

Feds to focus on health inequities among minority, rural and poor seniors

Minority patients have a higher rate of many chronic conditions, as well as a greater chance of having to return for a costly hospital visit after their first hospitalization. For diabetes patients, the highest rate of readmission was 15.9% for American Indian and Alaska Natives, followed by non-Hispanic blacks at 13.2%, Hispanic Americans at 12.8%, Asian Americans at 9% and whites at 7.6%.

A 2011 study found higher readmission rates among black patients with congestive heart failure, with the highest rates among black patients treated at hospitals with a predominantly minority population.

Patients who were part of a new recommended discharge process at the Boston University Medical Center had a 30% lower readmission rate in the 30 days after discharge. That saved the hospital more than $400 per person. These patients were also more likely to know what their diagnosis was and to follow up with their primary care doctor.

The prospective solutions go far beyond hospitals, however. The new CMS guide, written by researchers at Massachusetts General Hospital, includes examples involving telemedicine and partnerships with community groups.

Reed Tuckson, a primary care doctor and former Washington public health commissioner, applauded the effort.

"This is an American problem," says Tuckson, who  heads the American Telemedicine Association. "The culturally disadvantaged do face more challenges, but everyone of us has a stake in this if we are concerned about other human beings."