- Medicare will withhold an estimated record-high total of $528 million - an increase of $108 million from $420 million in 2015 - via readmission penalties on hospitals during the next year, with the average penalty increasing by a fifth to 0.73%, Kaiser Health News reported. The change will be the result of adjustments to how readmissions are calculated, KHN added.
- More than half of all U.S. hospitals (2,497) will be punished based on their rehospitalization rates for patients who were discharged from July 2012 through June 2015, according to KHN's analysis.
- The penalty charges are related to readmissions surrounding events of heart attacks, heart failure, pneumonia, chronic lung disease, hip and knee replacements, or coronary artery bypass graft surgery.
Readmission rates have decreased across the country after the Hospital Readmissions Reduction Program launched in late 2012 with the purpose of improving follow-ups after discharge.
But the penalties, created by the ACA and set to begin in October, highlight a shared concern among hospitals that have more low-income patients than others as these patients "can have more trouble recuperating, sometimes because they can’t afford their medications or lack social support to follow physician instructions, such as reducing the amount of salt that heart failure patients consume," as noted by KHN.
Hospitals will be charged with other fines in addition to readmission penalties based on quality measures and data reporting. Yet a 2015 study published in the Journal of Evaluation of Clinical Practice revealed what factors are indicative of high risk for unplanned readmissions, such as targeting patients with chronic cardiovascular or pulmonary diseases and discharge on a Friday.
When assessing hospitals' readmission rates, CMS calculated the total number of expected readmissions and patients' health in each hospital. If a hospital's unplanned readmissions exceeded expectations, its reimbursement for each case involving any Medicare patient will receive a reduction during FY 2017 of no more than 3%.
Hospitals that are exempt from the readmission penalties under the ACA (about 1,400) include critical access hospitals, those in Maryland as well as organizations that serve veterans, children, and psychiatric patients. In effort to improve readmission rates, CMS in May called for proposals to develop Hospital Improvement and Innovation Networks (HIINs) with the goal of reducing patient harm by 20% and 30-day readmissions by 12%.