The measure is not just about preventing readmissions of patients with conditions such as heart failure, heart attack, and pneumonia—for which Medicare already has a separate penalty—although that is clearly one of the agency's intents, DiLisi points out. With MSPB, overly inefficient care to any patient, including a 30-day readmission of patients with any diagnosis, is captured and potentially penalized.
The CMS officials would seem to agree. In its final rule on the matter in August 2013, the agency said the MSPB measure "incentivizes hospitals to work on redesigning care systems and coordinating with other providers of care, which can have a significant impact on the quality and efficiency of services."
The regulators acknowledged the many letters of objection and requests to delay the measure. But they emphasized they "continue to believe that hospitals have a significant influence on Medicare spending during the episode surrounding a hospitalization, through the provision of appropriate, high-quality care before and during inpatient hospitalization and through proper hospital discharge planning, care coordination, and care transitions."
Language in the measure, which received the National Quality Forum's endorsement in December 2013, makes clear the measure will encourage hospitals to work on "shifting postacute care from more expensive services (e.g., skilled nursing facilities) to less expensive services (e.g., home health) in cases that would not affect patient outcomes."
The language of the measure points to the much higher increase in long-term care costs over home health costs. It says "hospitals can identify individuals at high risk of permanent nursing facility placement at the time of hospital discharge. Improved discharge planning may improve the chances that these patients can return home."
But one part of the new measure's implementation that makes some industry leaders nervous is this: In addition to posting each hospital's MSPB score on Hospital Compare, CMS is also publicly posting spreadsheets on data.medicare.gov showing detailed average beneficiary spending for each of seven care settings for the three time periods in the MSPB equation, or 21 categories, for every one of 3,320 hospitals affected by the rule.
This enables anyone—including payers, employers, and competitors—to compare, for example, Medicare's skilled nursing home payments during the 30-day postdischarge period. These numbers show national cost variations of more than six-fold, despite being price-standardized for geographic payment differences and risk-adjusted for patient health status.