- Illinois' Department of Healthcare and Family Services will collect $16.3 million from 82 hospitals that were unable to acceptably reduce readmissions during the 2013 fiscal year.
- Much like Medicare is levying fines against hospitals for excessive readmission rates, so is the state of Illinois. Each hospital was assigned an acceptable rate of annual preventable readmissions. Hospitals that exceeded the limit were fined or experienced Medicaid reimbursement reductions.
- In 2013, 147 hospitals had too many patients readmitted within 30 days of discharge for a reason related to the original admission. 65 hospitals were able to avoid $18.5 million in penalties by putting policies in place to reduce readmissions, while the remaining 82 were left on the hook. Nine hospitals were dinged with over $500,000 in fines, with three owing over $1 million. Meanwhile, the program has recouped $5.6 million in Medicaid payment reductions to date.
Many hospitals on the list are those with larger numbers of low-income patients or academic medical centers treating patients with complex conditions, causing some providers to question the state's methodology in calculating an acceptable readmission rate.
"We do not believe that the methodology adequately addresses the readmission of children with complex medical conditions, of which Lurie Children's is the highest volume provider in the state," Julie Pesch, spokesperson for Ann & Robert H. Lurie Children's Hospital of Chicago, told the Chicago Tribune. The hospital owes $1.43 million. Rush University Medical Center, which owes $855,000, pointed to the large proportion of medically-complex Medicaid patients it treats as the driver behind high readmission rates.
On a national level, the Centers for Medicare and Medicaid Services recently announced its penalties of $227 million for 2,225 hospitals, with safety nets the most likely to be dinged. More than 1,000 hospitals nationally were able to avoid penalties by reducing readmissions. It is likely more providers will work on keeping patients from returning to hospitals unnecessarily, particularly if CMS follows through on expanding the number of services they look to for penalties: The agency is increasing its maximum penalty to 3% for all patient stays this year and is considering adding more conditions, like knee replacements, to those analyzed.