An improved Medicare picture points to better outcomes

BALTIMORE––Nephrologists joining the fight with other Medicare physicians and legislators to eliminate the archaic sustainable growth rate, which governs what Medicare pays physicians, can point out that the Medicare program itself has tighten its belt over the last five years.

“Medicare per capita spending growth for patients in the program has been the lowest in history over the last four years,” noted Patrick Conway, MD, MSc, who serves as Deputy Administrator for Innovation and Quality and is the Chief Medical Officer at the Centers for Medicare and Medicaid Services during a talk for the Renal Physicians Association’s annual meeting here. Since 2010, it has gone no higher than 2.25% in a given year.

Likewise, 30-day hospital readmission rates are down for all causes to around 17%. “That means over 130,000 patients are staying home” that would have ended up back in the hospital, Conway said (U.S. Renal Data System data indicates that among prevalent hemodialysis patients in 2011, 36% of discharges from the hospital were followed by a re-hospitalization within 30 days).

Conway said Medicare has also seen a significant reduction in central line bloodstream infections, or CLABSI. Over 1,000 intensive care units achieved an average 41% decline in central line-associated bloodstream infections over six quarters (18 months) from 2009-2012. The number of cases dropped from 1.915 to 1.133 CLABSI per 1,000 central line days. The rates for hospital-acquired conditions went down 9% across all measures from 2010-2012 as well, Conway added.

The results fit in with the six priorities of CMS’s National Quality Strategy that rewards providers and health systems that deliver better outcomes at lower cost to both patients and Medicare. The strategies are:

Make care safer by reducing harm caused in the delivery of care
Strengthen person and family engagement as partners in their care
Promote effective communication and coordination of care
Promote effective prevention and treatment of chronic disease
Work with communities to promote healthy living
Make care affordable

NQS’s three aims include:

Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.

Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and environmental determinants of health in addition to delivering higher quality care.

Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government. Making quality care more affordable for individuals, families, employers, and governments comes by developing and spreading new health care delivery models. “Improving the quality of care means defining the end goal, not necessarily the process for achieving it,” said Conway. “We need to make major investments in quality improvement.”