Medicare Eases Readmission Penalties Against Safety-Net Hospitals


Since the sanctions began, Medicare has evaluated every year rates for readmitted patients who had originally been treated for heart failure, heart attacks and pneumonia. And contains reduced its payments to more than half of hospitals according to those rates. The evaluations have since expanded to pay for chronic lung disease, hip and knee replacements and coronary artery bypass graft surgeries.

Medicare counts patients who returned to a hospital within 30 days, even if it is a different hospital than the one which originally treated them. The penalty is used towards the first hospital.

Medicare exempts hospitals with not enough cases, those serving veterans, children and psychiatric patients, and critical-access hospitals, which are the only hospitals at your fingertips of some patients. In addition, Maryland hospitals are excluded because Congress lets that state set its very own rules how it distributes Medicare money.

In its revised method this season, Medicare distinguished hospitals that serve a high proportion of low-income patients by taking a look at what percentage of the hospital's Medicare patients were also entitled to Medicaid, the state-federal program for that poor. American Hospital Association officials state that when they considered this a noticable difference, it isn't a perfect reflection of poor patients. For one thing, they are saying, hospitals in states with increased restrictive Medicaid coverage don't appear through this formula to possess as challenging patient populations just like hospitals in states with higher Medicaid eligibility.

Akin Demehin, the association's director of quality policy, said CMS might consider linking its records to Census records that demonstrate income and education degree of patients.

“It might provide you with a more precise adjuster,” he said.

The hospital industry remains critical from the overall program, stating that stripping hospitals of revenue due to poor performance only makes it harder for them to care for patients.

Congress' Medicare Payment Advisory Commission in June concluded that the penalties from previous years successfully pressured hospitals to lessen the numbers of returning patients – and helped save Medicare about $2 billion a year.

In its research into the approach's effectiveness, Congress' advisory commission rejected some of the hospital industries' complaints about Medicare's Hospital Readmissions Reduction Program: that hospitals may have attempted to get around the penalties by keeping patients under “observation status” and that discouraging rehospitalizations may have resulted in extra deaths.

The commission discovered that between 2010 and 2021 readmission rates fell by 3.6 percentage points for cardiac arrest, 3 percentage points for heart failure and 2.3 percentage points for pneumonia. Simultaneously, readmissions brought on by problems that don't factor in to the penalties fell typically 1.4 percentage points, indicating hospitals were focusing on lowering unnecessary readmissions that could hurt them financially.

The commission wrote: “We conclude the [penalties] contributed to a substantial decline in readmission rates without creating a material increase in ED [emergency department] visits, a material rise in observation stays, or a net adverse effect on mortality rates.”

This fall, Medicare will attack the readmissions from another angle by issuing penalties on skilled assisted living facilities that send recently discharged residents back to a healthcare facility too often.