Dive Brief:
- A bipartisan group of 34 House members sent a letter June 10 asking HHS and CMS to be careful that Medicare’s penalties for hospital readmissions don’t have an unfair impact on safety-net hospitals serving poor communities.
- Specifically, the group urged CMS to work with Congress to help ensure that the readmission reduction program doesn't harm providers serving dual-eligible beneficiaries and low-income seniors.
- The program, established by the Affordable Care Act, took effect in federal fiscal year 2013. In the first year, CMS cut Medicare reimbursement by up to 1% for 2,213 hospitals with high readmission rates for heart attack, heart failure and pneumonia. Under the second round of penalties, starting Oct. 1, 2013, CMS decreased Medicare payments to 2,225 hospitals in 49 states by up to 2%.
Dive Insight:
The program looks for Medicare hospital readmissions within 30 days of discharge, and with some exceptions, CMS imposes penalties when a hospital's readmissions exceed its expected rate. Starting Oct. 1, stakes get higher as penalties rise to as much as 3% and more medical conditions are added.
Federal lawmakers, swayed by the hospital industry's assertion that the program is flawed, cited its disproportionate impact on the nation's safety-net hospitals. They asked CMS to ensure that it won't penalize hospitals for readmissions unrelated to the initial reason for admission, noting studies have found hospitals are being penalized for numerous readmissions more closely tied to community factors than hospital quality. Rep. Jim Renacci (R-Ohio), who spearheaded the recent letter, introduced a bill in March (H.R. 4188) that would require the program to take into account socio-economic factors. It awaits action in the House Ways and Means Committee.
The House members' letter concludes by stating that reducing readmissions cannot be placed squarely on the shoulders of hospitals alone: It is a shared responsibility involving the hospital, patient, social services professionals and providers across the continuum of care.
