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Libraries and Medicare Bonuses, Penalties

Background on Medicare Bonuses and Penalties

For the past two years, Medicare reimbursements have been tied to how well a hospital meets effective care and readmission metrics. If the hospital does better than the quality care standard, it gets a bonus. If the hospital doesn’t meet the standard, it gets a penalty. The hospital can get a bigger bonus or bigger penalty based on how well it meets the standard or not. For the readmission metric, institutions want to stay below the set limit of hospital readmissions. If they exceed this limit, they receive a penalty.


The NN/LM MCR distributed a questionnaire through our listserv to hospital Network members. We wanted to hear what members are doing to assist their hospitals in addressing the Medicare metrics since this can translate into dollars gained (bonuses) or dollars lost (penalties). Activities of our members would then be shared with others in the region to stimulate ideas of what librarians can do.

The questionnaire was a very short one. Members were asked if they were involved in programs looking at readmission rates or quality control at their institution. If they answered “yes,” they were asked to describe their activity. They were also presented a list of the Medicare metrics and were asked to check off all the ones to which their activities relate.


Of the 84 hospitals who are Full members, fifteen (18%) responded to our questionnaire on quality activities. Participation came from all states except Nebraska and Wyoming. The cohort is not large enough to draw any reliable conclusions. This article will share the responses and make some speculations.

The majority of respondents are involved in looking at readmission rates and/or quality control activities. How are they involved? They are doing literature searches and document delivery and/or are participating in their hospital’s efforts (committee, project, task force) addressing one or more of the Medicare metrics. In some instances librarians are leading the effort.

Literature searches/document delivery:

  • On patient safety issues
  • To reduce readmission rates
  • To create clinical practice guidelines
  • To support value analysis. Value analysis compares available products by seeking literature to determine safety and efficacy of products being considered for purchase.
  • To proactively forward information to managers and administration

Integration in hospital efforts:

  • Co-leader of Health Literacy Committee
  • In charge of the QOPI (Quality Oncology Practice Initiative) certification
  • Member of Lean project focused on the provision of patient education in the After Visit Summary
  • Committee member:
    • Quality control committees such as reducing falls rate
    • Evidence Based Practice Collaborative
    • Committees for transitions of care
    • AIM (Advanced Illness Management)
    • Medical Staff Education

Medicare effectiveness metrics are divided into two categories: the first group addresses patient care and the second group addresses patient satisfaction. The staff of seven responding libraries address up to 21 of the Medicare effective care metrics.

The top three patient care metrics that they are addressing are:

5 (71%) Discharge Instructions
4 (57%) Averting Blood Clots in Surgery Patients
4 (57%) Averting Catheter Infections

The top three patient satisfaction metrics they are addressing are:

5 (71%) How well nurses communicated with patients.
5 (71%) How well doctors communicated with patients.
4 (57%) How clean and quiet the hospital room and hall were.

The first two have health information literacy components that librarians are well suited for.

The libraries are minimally or moderately involved in addressing the Medicare metrics. Of the 21 metrics that could have been checked, five libraries addressed 0-2 metrics and an equal amount addressed 7-9 metrics. One respondent checked all of the metrics.

Librarian Activity versus Bonuses and Penalties

[Note: For three institutions Medicare had no data. Hospitals that are critical access facilities, certain cancer hospitals, and places with too few cases to be accurately measured are excluded.]

Does a librarian make a difference in how well the institution does against the Medicare metrics? The short answer is, “No, not so much.” We looked at the change occurring between the first and second year of this program. The institutions with active librarians were compared to institutions with librarians without this focus. There was little difference in the improvement between the two sets of institutions.


Overall, there was no significant difference between hospitals where the librarian was actively addressing the Medicare metrics and those where the library was not actively addressing the Medicare metrics. However, institutions that were part of this study are doing better in meeting the readmission criteria than the quality of care criteria. Librarian activities may play a role with providing information on reducing readmission rates and improving health care provider communication with patients. There is opportunity for hospital librarians to work within their institutions to improve the Medicare reimbursements. The activities described by the members who responded to the questionnaire provide examples as a place to start.

-Claire Hamasu, Associate Director

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