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As a hospitalist myself, I have seen firsthand the need for a healthcare system that provides better care, spends dollars more wisely, and keeps people healthier. I practice on weekends taking care of children, many of whom have multiple chronic conditions and fragile social support, and their families. I love patient care; however, too many times, we hospitalists see patients whose fragmented care results in poor outcomes and repeated hospitalizations.
In my current role at the Centers for Medicare and Medicaid Services (CMS), I am pleased to see that Secretary Burwell is confronting these problems head on, with concrete goals for shifting the equation in how we pay for care. Specifically, we announced the goal of moving 30% of payments by 2016 into alternative payment models such as accountable care organizations (ACOs) or bundled payments, where the provider is accountable for total cost of care and quality. We set the goal of 50% of payments in these models by 2018. In 2011, Medicare had essentially zero payments in these models, but by 2014, we have reached 20% and growing in alternative payment models. Hospitalists can play a significant role in this healthcare transformation, and several initiatives in CMS’ Innovation Center, which I lead, are relevant to our work.
Recently, a Department of Health and Human Services (HHS) report showed that an estimated 50,000 fewer patients died in hospitals, 1.3 million fewer adverse events and infections occurred, and approximately $12 billion in healthcare costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. This progress toward a safer healthcare system occurred during a period of concerted attention directed by hospitals and hospitalists throughout the country at reducing adverse events. These efforts were also due in part to provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative. The Partnership for Patients is a nationwide public-private collaboration that began in April 2011 with two main goals: Reduce preventable hospital-acquired conditions by 40% and 30-day readmissions by 20%. Since the Partnership for Patients was launched, the vast majority of U.S. hospitals and many other stakeholders have joined the collaborative effort and delivered results.
CMS is committed to making even greater progress toward keeping people as safe and healthy as possible. That is why we have launched a second round of Hospital Engagement Network (HEN) contracts to continue reducing preventable hospital-acquired conditions and readmissions. HEN funding will be available to award contracts to national, regional, or state hospital associations, large healthcare organizations, or national affinity organizations that will support hospitals in their efforts to reduce preventable hospital-acquired conditions and readmissions. In February, CMS posted a request for proposals for HEN contracts to continue the success achieved in improving patient safety.
The Partnership for Patients and HENs are just one part of an overall effort by HHS to deliver better care, spend dollars more wisely, and improve health. Initiatives like the Partnership for Patients, accountable care organizations, quality improvement organizations, and others have helped reduce hospital readmissions in Medicare by nearly 8% between January 2012 and December 2013—translating into 150,000 fewer readmissions. Hospitalists have played a major role in these improvements.
On a broader front, CMS is taking action to improve healthcare so patients and their families can get the best care possible. To this end, CMS is focused on three key areas: (1) improving the way providers and hospitals are paid, (2) improving and innovating in care delivery, and (3) sharing information more broadly with providers and hospitals, consumers, and others to support better decisions.