penalties for patient re-hospitalization

In October the new CMS (Centers for Medicare and Medicaid Services) penalties for patient re-hospitalization went into effect. More than a half a billion dollars in hospital payments will be withheld from more than half of the nation’s hospitals by Medicare over the next year. (view source).  That’s a good many hospitals losing a great deal of money.

How did CMS determine whom to sanction? CMS acquired data from tracking patient readmissions within thirty days of being released for one of these conditions: heart attacks, heart failure, pneumonia, chronic lung disease, hip and knee replacements and coronary artery bypass graft surgery. Using data about Medicare patients who were hospitalized July 2012 through June 2015, CMS compared the amount of expected readmissions to the amount of total readmissions. Hospitals that exceeded the expected readmission amount will be penalized with a reduction in each Medicare case reimbursement for the next fiscal year. These penalties add up.  CMS is expecting to dole out $538 million in fines, $108 million more than last year.

One of the biggest issues with readmissions appears to be the patient population itself. There are certain patient characteristics that make readmission more likely. Medicaid patients and uninsured patients are at increased risk of readmission as are patients with limited English proficiency. Additionally, the medical complexity of a case impacts the likelihood of a readmission.

What is a hospital to do to reduce readmissions and avoid these reductions? Beckers Hospital Review article on 10 Proven Ways to Reduce Hospital Readmissions offers some ideas.  (view source).  Of course, one article is not going to provide the answer but it is a place to start. 

If you are looking for assistance in reducing readmissions in your facility, you can find help at the National Readmissions Prevention Collaborative. This volunteer collaborative provides case studies that outline Best Practices and industry-leading tools to help facilities reduce readmissions. For more information on the National Readmissions Prevention Collaborative, check out their website at www.nationalreadmissionprevention.com.