« The Dual Agenda: September 17, 2014 Issue

Noteworthy News

New Study on Hospital Readmission Rates in Medicaid Population

The Altarum Institute reported on a new study conducted by state medicaid directors, AcademyHealth, and the Agency for Healthcare Research and Quality seeking to better understand hospital readmission rates in the Medicaid population. Based on data from 19 states, the study reports an average Medicaid population hospital readmission rate of 9.4 percent, averaging $77 million per state. The study also identified the five diagnostic groups that accounted for 57 percent of readmissions: mental and behavioral disorders, pregnancy, childbirth and associated complications, and diseases of the respiratory, digestive and circulatory systems. The study also notes that because the needs of Medicaid and Medicare populations are often quite different, the disease management programs used in Medicare do not necessarily focus on the diagnoses prevalent in the Medicaid population.

Memoir Makes Clear How Difficult Health System Transformation Will Be

A blog post by Chris Langston, Program Director at the John Hartford Foundation, is a must-read for anyone interested in the challenges presented by health system transformation. The post is a discussion of a new memoir written by Dr. Sandeep Jauhar. Dr. Jauhar is a cardiologist who mostly treats older patients, and he tells a story of unnecessary testing and hospitalizations, unrealistic expectations by patients and families, and unresponsive managed care plans. His memoir illustrates the ways in which what is good for physicians is pitted against what is good for patients, insurers, and others in the healthcare system. Dr. Jauhar’s memoir makes it clear just how difficult health system transformation will be, as success will require behavior changes on the part of every single stakeholder.

Federal Lawsuit in California Targets Overmedication in Nursing Homes 

A story on National Public Radio details a new strategy for transforming care in nursing homes: federal lawsuits. The federal government is suing two nursing homes in California, accusing the facilities of overmedicating their patients. Overmedication is a persistent cause of health problems in nursing homes, and the improper use of antipsychotic drugs is of particular concern. In each of these cases, the U.S. Attorney for Northern California is suing for improper use of antipsychotics, and because these drugs are widely prescribed in nursing homes, this approach could become a model for other suits around the country. The dollars at stake are significant: the federal government can seek to recover any Medicare and Medicaid charges paid, request triple damages, and seek fines for false medical reporting.

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