The Post-Hospitalist Company Dramatically Reduces Hospital Readmissions Again in 2017 Through Its’ Proprietary Care Coordination Program
October 24, 2018
CMS releases 2017 – Physician’s Quality and Resource Use Report (QRUR).
General Medicine, P.C. – The Post Hospitalist Company has for the sixth year in a row scored one of the highest ratings nationally for their proprietary Care Coordination Program that manages Hospital Readmissions. Their 2017 Rate was 7.7% which scores them 66% better than ALL other providers in their peer group. The national average rate was 22.6%.
This achievement has once again consistently placed General Medicine in the Top 5% of providers nationwide since measurements began in 2012. As a result, their client hospital readmission rates have dropped saving millions in penalties, while establishing performance rewards and financial incentives.
With six years of performance measurement now completed, CMS has demonstrated that preventing unnecessary and potentially preventable hospital readmissions is achievable when a dedicated physician appropriately manages patients, and accurately decides if they need to be sent out to a hospital. This decision-making process is now recognized as the single most important factor having critical impact on readmissions. NOW, having great attending physicians and Medical Directors managing Post-Acute and Long-term Care patients matters more than ever before.
On October 1, CMS began fully implementing PAMA, the “Protecting Access to Medicare Act of 2014”. Their focus in this law is the prevention of avoidable and unnecessary hospital admissions to reduce overall healthcare expenditures. Effective immediately, all Post-Acute and Long-term Care facilities (SNF’s) will begin to be penalized up to 2% of their Medicare reimbursements for high readmission rates. Others with low rates will receive incentives. The critical factor for each facility to achieve lower rates will be to utilize physicians who have superior performance experience managing readmissions, and who are committed to working with facilities to lower their rates going forward.
About General Medicine – The Post-Hospitalist Company:
This independent physician group has over 30 years of experience specializing in the care of patients living in Post-Acute, Long-Term Care and Assisted Living facility settings. Their clinicians (both physicians and collaborative nurse practitioners) perform care coordination with MCO’s, ACO’s, hospitals, health systems and post-acute teams. They provide “on-site” assessment, treatment, oversight, and follow-up to each patient’s personal care plan with regularly scheduled hours at each facility and patients are treated based upon their needs, and medical necessity.
These clinicians pride themselves on quickly responding to calls and improving quality of care. With low staff turnover, no usage of “Locum Tenens” providers and 24/7 service, their group, assists Health Plans, nursing facilities and referring hospitals to decrease readmissions and prevent unnecessary ER visits. They also consult with MCO’s, ACO’s, BPCI partners, Hospitals and facilities to develop key strategies to reduce readmissions/penalties while maintaining/increasing occupancy, enhancing BPCI achievements, and developing relationships.
Key Achievements for General Medicine:
- Hospital readmission rate of 7.7% is 66% below national average of 22.6%.
- Consistently has scored in the Top 5% of providers nationally since measurement started in 2012.
- Consistently has achieved Top 5% national QRUR performance since 2012.
- Client Health Plans have achieved Top 10% HEDIS results since 2012.
- Client referral hospitals have saved millions in readmission penalties since 2014.
- Contracted with 19 of the top 20 MCO’s, and hundreds of Insurance Companies nationwide.
- Quality Care provided to more than 60,000 patients in over 1,000 facilities, in 13 states.
Specific Benefits Clients Realize using their Proprietary Care Coordination/Post-Hospitalist Services:
Hospitals and Nursing Facilities Use a Recognized Solution to:
– Reduce avoidable admissions and readmissions
– Reduce unnecessary ER utilization
– Reduce overall health care spending
– Improve the process of transitions between hospital, post-acute care and home.
– Improve patient health outcomes and satisfaction scores.
MCO’s Realize Huge Cost Savings.
According to an independent evaluation from the University of Illinois at Chicago, the State of Illinois’ Integrated Care Plan reduced its hospital readmission rate for post-acute Medicaid patients by 18 percent in the first year. In addition, the plan saw a 15 percent decrease in the rate of ER visits resulting in a hospital admission, and a 39 percent decrease in the percentage of high-frequency emergency department users.
ACO’s Save More Money.
According to a recent study in the New England Journal of Medicine, physician group-led Accountable Care Organizations (ACOs) were associated with greater savings for Medicare; (MSSP) Medicare Shared Savings Program reductions constituted a net savings of $256.4 million in 2015.
Client Testimonials and Information is available online at www.generalmedicine.com.
For questions or comments, please contact Dr. Thomas M. Prose, President and Senior Medical Director, General Medicine, P.C. – The Post-Hospitalist Company, 21333 Haggerty Road, Suite 150, Novi, Michigan 48375, or call 800-979-9595.