- The CMS Hospital Readmissions Reduction Program will levy its lightest penalties in nearly a decade, after excluding some pandemic-related data from its calculations for fiscal year 2023, according to a Kaiser Health News analysis published Tuesday.
- Excluded from the CMS’ latest readmissions review is first-half 2020 data for Medicare patients and data for those readmitted to hospitals with pneumonia, due to the substantial impact of COVID-19.
- CMS’ average payment reduction to hospitals of 0.43% is the lowest since 2014. The agency will impose penalties on 2,273 hospitals, the fewest since 2014, KHN reported.
CMS’ move to exclude pandemic-affected data from its readmissions calculations offers some financial relief to hospitals still struggling to recover from COVID-19’s fallout. Many remain challenged by inflation and staff turnover after exhausted clinicians left jobs.
Akin Demehin, senior director of quality and patient safety policy at the American Hospital Association, told KHN that the CMS’ changes to the HHRP were warranted given the pandemic’s impact on care patterns at hospitals.
Part of the Affordable Care Act, the HRRP aims to encourage improvements in quality of care by linking hospitals’ Medicare payments to performance measures for excess readmissions. Hospitals are assessed on readmissions relative to other facilities, and the CMS reduces payments by up to 3% for those that fall short.
The program measures 30-day unplanned readmissions for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, coronary artery bypass graft surgery and elective total hip or knee replacement. The pneumonia readmission measure will be added back in fiscal 2024.
Hospitals affected by penalties in 2023 represent 43% of the country's 5,236 facilities, KHN said.
Payment reductions will be applied from October 2022 through September 2023. Penalties are expected to total $320 million over the period, and some hospitals will see their fines greatly reduced from last year, the report said.