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Gentlemen and Ladies, Start Your Engines

January 11, 2011
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Readmissions and value-based purchasing: emerging together

Buried in last Friday’s announcement that CMS had released its proposed rule on the new Medicare value-based purchasing program for hospital care was a very, very important nugget. And that is that CMS plans for the program, mandated by the federal healthcare reform legislation passed last March, to encompass 30-day readmission rates for Medicare patients diagnosed with acute myocardial infarction, heart failure, and pneumonia. That’s on top of the other measures that will be in the program, of course.

Now we all know (or at least we should) that “unnecessary readmissions” was an area that was also covered by its own provision under the Affordable Care Act. So we already knew that readmissions was going to be a major focus for hospitals going forward in any case. But the fact that CMS is including one element of readmissions in the value-based purchasing program only adds to the significance of readmissions as an emerging key focus for the Medicare program.

And in that context, it’s clear that the vast majority of hospital organizations in the U.S. are only in the earliest phases of being able to analyze—let alone take action—on their readmissions rates in various care areas and for various conditions. And those are the hospitals that have even begun work in this highly challenging arena.

At Healthcare Informatics, we will of course be covering these two areas—value-based purchasing and readmissions analysis and work—as they continue to emerge out of healthcare reform. But what’s clear here is that CIOs, CMIOs and other healthcare IT leaders, will need to sit down with their organization’s top clinical and administrative leaders now, and begin to at least map out a pathway to a strategy. The fact that the value-based purchasing program will begin at the start of fiscal year 2013 means, in healthcare terms, that it is just around the corner. In other words, stat. I would be very interested in hearing from CIOs and other readers on their initial experiences in this area. They are welcomed to e-mail me at

In the meantime, here are two items to be added to everyone’s “urgent to-do” list—along with everything else, of course!

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