More Pressure on PCPs to Reduce Hospital Readmissions

Paul Cerrato, MA


March 04, 2015

In This Article

Ways You May Be Held Accountable

If you work in ambulatory non-inpatient setting, either as an independent practitioner or an employee of a group practice, how will the push to lower readmissions affect you? That largely depends on whether you are part of a hospital-owned network, and whether you are in a strictly fee-for-service setting or work in some sort of pay-for-performance system.

"If you're a hospital-employed PCP [working in an ambulatory setting], you may see some mandates from your practice managers," explains Newman. In contrast, physicians in Dr Newman's independent group practice are not currently penalized for their readmission rates.

Office-based physicians committed to some sort of pay-for-performance system may also face financial pressures to lower their readmit statistics.

Practices that have contracts with private insurers that offer bundled payments may find they are losing money if their patients' combined inpatient and outpatient care exceeds certain financial thresholds, for instance.

To help rein in costs, some group practices are now giving physicians report cards that take into account readmission rates. "When doctors and healthcare teams in the outpatient sector start to get rewarded for doing what is needed to prevent 30-day readmissions, then it becomes much easier to make the commitment in time, energy, and resources" says Leonard Fromer, MD, executive director of Group Practice Forum, which advises group practices on how to improve care coordination.

Those rewards, says Fromer, often include a report card arrangement to evaluate physicians' performance and compensation. Such evaluation protocols can include readmission rates, productivity, and patient satisfaction.

But Fromer emphasizes the need to fairly measure readmission rates. That includes risk stratification that takes into account disease severity and the amount of chronic disease in each doctor's patient panel. It's unfair to penalize a clinician for high readmission rates if her patients are much sicker than those of her colleagues.

Turning Obstacles Into Opportunity

If you're working in a strictly fee-for-service setting and are not owned by a hospital, most experts agree that the Readmissions Reduction Program will have virtually no impact on your bottom line—at least for now. As currently written, the regulations only penalize hospitals.

But many PCPs in private practice see the writing on the wall. Instead of waiting for government and private insurers to force them into a performance-based reimbursement system that does factor in readmission rates, they are forming accountable care organization (ACOs) and similar arrangements that can become more profitable if managed wisely.

A good example is the Palm Beach ACO, a physician-run ACO that saved $22 million in its first year and was able to obtain $11 million in shared savings as part of the Medicare Shared Savings Program. An important component of this physician-controlled ACO included transitional care measures to keep patients out of the hospital. A report from the American Academy of Family Practice pointed out that the ACO "receives as much as $244 for a highly complex transitional care visit...and can bill $173 for consulting a transitional patient within 14 days of hospital discharge if the care is not considered complex."[6]

Although it's unlikely that such reimbursement fees alone are going to add $11 million to your bottom line in one year, combining them with all the other strategies, including medication reconciliation, reviewing discharge summaries, and making early follow-up phone calls, can turn the race to lower readmissions into a win/win situation for you and your patients.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: