Even though we are set to inaugurate a new president of the United States who vowed to abolish Obamacare, I believe that Donald J. Trump will not touch provisions that address perceived cost inefficiency or quality within our healthcare system. In fact, if you’ve read CMS’ game plan for transforming healthcare published in JAMA in 2014, note that many of these provisions began with George W. Bush and have been embraced by the AMA with the implementation of MACRA.
The 30-day all cause acute myocardial infarction (AMI) mortality outcome measure has been linked to hospital payments since the inception of the Hospital Value-Based Purchasing Program (HVBP) in fiscal year 2013. In February 2016, CMS announced that 70% of commercial payers have agreed to use this measure as one of the cardiology outcomes linked to payment.
Having performed discharge planning for many, many years, I’ve learned one key component is now more true than ever: Assessments must be very comprehensive. We are dealing with a wider variety and different mix of patients. For example, we are seeing an older population that is living longer, often with dementia. These are patients with multiple comorbidities who are living on a limited income. We also are dealing with a larger group of patients—again, with multiple comorbidities—who are living longer due to medical advances and require costly medications and repeated readmissions for complications or procedures. Additionally, we care for the homeless, who are often riddled with mental health or drug addiction problems as well as comorbidities.
