The Centers for Medicare & Medicaid Services will penalize more than 2,200 hospitals beginning in October for failing to meet standards regarding readmission rates, according to a report by Kaiser Health News.
Only about 34% of hospitals avoided the penalty based on three years of administrative claims data. About 8% — 278 hospitals in all — incurred the maximum penalty of 1% of a hospital’s base Medicare reimbursement rate per discharged patient.
The maximum penalty rises to 2% for discharges starting in October 2013 — based on readmissions data from July 2008 through June 2011 — and to 3% the following year.
The projected $280 million in penalties for the 12-month period is about 0.3% of the total amount hospitals receive from Medicare, according to Kaiser Health News.
Criteria
As created by the Affordable Care Act, the Hospital Readmissions Reduction program adjusts hospital payments based on excess readmissions of Medicare patients following acute myocardial infarction, heart failure and pneumonia hospitalizations. Similar 30-day readmission measures also are available to the public on the Hospital Compare website.
The measures adjust for differences in each hospital’s patient-case mix, meaning hospitals that care for older and sicker patients should not be at a disadvantage.
Some hospital stakeholders have noted that hospitals with lower 30-day mortality rates may be vulnerable to higher readmission rates, and should not be penalized.
In a fact sheet, CMS responded: “Readmission of patients who were recently discharged after hospitalization with AMI, HF or pneumonia represents an important, expensive and modifiable adverse outcome. The risk of readmission can be modified by the quality and type of care provided to these patients.
“The readmission and mortality measures contain complementary information, and consumers should consider a hospital’s mortality and readmission results together. Consumers should talk to their doctor about how the outcome measures results are relevant to their situation.”
For more on the readmissions penalties, including a complete list of penalized hospitals, see www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx.
For more on the Hospital Readmissions Reduction Program, see http://go.cms.gov/SiMtNl and http://go.cms.gov/OK8hTp.
Only about 34% of hospitals avoided the penalty based on three years of administrative claims data. About 8% — 278 hospitals in all — incurred the maximum penalty of 1% of a hospital’s base Medicare reimbursement rate per discharged patient.
The maximum penalty rises to 2% for discharges starting in October 2013 — based on readmissions data from July 2008 through June 2011 — and to 3% the following year.
The projected $280 million in penalties for the 12-month period is about 0.3% of the total amount hospitals receive from Medicare, according to Kaiser Health News.
Criteria
As created by the Affordable Care Act, the Hospital Readmissions Reduction program adjusts hospital payments based on excess readmissions of Medicare patients following acute myocardial infarction, heart failure and pneumonia hospitalizations. Similar 30-day readmission measures also are available to the public on the Hospital Compare website.
The measures adjust for differences in each hospital’s patient-case mix, meaning hospitals that care for older and sicker patients should not be at a disadvantage.
Some hospital stakeholders have noted that hospitals with lower 30-day mortality rates may be vulnerable to higher readmission rates, and should not be penalized.
In a fact sheet, CMS responded: “Readmission of patients who were recently discharged after hospitalization with AMI, HF or pneumonia represents an important, expensive and modifiable adverse outcome. The risk of readmission can be modified by the quality and type of care provided to these patients.
“The readmission and mortality measures contain complementary information, and consumers should consider a hospital’s mortality and readmission results together. Consumers should talk to their doctor about how the outcome measures results are relevant to their situation.”
For more on the readmissions penalties, including a complete list of penalized hospitals, see www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx.
For more on the Hospital Readmissions Reduction Program, see http://go.cms.gov/SiMtNl and http://go.cms.gov/OK8hTp.
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