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Highmark Stresses Low Readmission Rates

Come fall, the federal government's Centers for Medicaid and Medicare Services (CMS) agencies will no longer provide incentives for hospitals with low numbers of patients who are readmitted to the hospital after 30 days of discharge. Despite that, Highmark is continuing an emphasis on low readmission rates by requiring the majority of hospitals participating in its pay-for-performance Quality Blue plan to report readmission numbers in 2013.

Page Babbit, Director of Provider Engagement at Highmark, said the program has many goals, but a main purpose is reducing readmissions.

"How we want them to get to that particular change is focusing on transitions of care," Babbit said. "By that I mean making sure that we're communicating with the patient and their caregivers to make sure they understand their diagnosis, they understand their medications, they understand the plan and understand how to take care of themselves once they leave that institution."

Babbit added that hospital and next-level provider communication also ensures the care continues properly, and furthermore reduces the likelihood of readmission.

The Highmark program began in 2001 and rewards hospitals based on a variety of indicators that measures the hospitals' quality of care and performance. Previously, the 93 participating hospitals could choose which pay-for-performance indicators to report. Now, level two and three hospitals that report less than a 7% readmission rate will be required to report that data in 2013. That means 63 will have to report readmission data in the next fiscal year.

Babbit said it is "critical" that hospitals focus on their readmission rates.

"So what we're trying to do is just, rather than be the stick in the situation," Babbit said, "provide the carrot to our facilities to encourage them to reach higher and to strive to produce a better quality product thus reducing readmissions in the end."