News EXPERT ADVICE & TIPS

Hospitals Penalized on 10/1 for Medicare Readmissions

10.03.19 ·

BEGINNING ON OCTOBER 1, 2019, 83% OF THE HOSPITALS EVALUATED IN “THE HOSPITAL READMISSION REDUCTION PROGRAM,”WHICH IS PART OF THE AFFORDABLE CARE ACT,  WILL BEGIN HAVING THEIR MEDICARE PAYMENTS REDUCED FOR EACH MEDICARE PATIENT. THE AVERAGE PENALTY WITH BE A 0.71% DECREASE IN PAYMENT FOR EACH MEDICARE PATIENT, AMOUNTING TO APPROXIMATELY $563 MILLION OVER THE NEXT YEAR.

 

THE PROGRAM MONITORS THE FREQUENCY OF READMISSIONS FOR SPECIFIC DISEASE STATES. THEY INCLUDE HEART FAILURE, HEART ATTACK, PNEUMONIA, CHRONIC LUNG DISEASE, HIP AND KNEE REPLACEMENT, AND CORONARY ARTERY BYPASS GRAFT SURGERY. SCHEDULED REAMISSIONS ARE NOT COUNTED. ADDITIONALLY,  IF A PATIENT IS READMITTED TO A DIFFERENT HOSPITAL, THE PENALTY RESTS WITH THE FIRST HOSPITAL.

 

THE PROGRAM BEGAN IN 2012 AND THERE IS DISCUSSION IF THE PROGRAM HAS IMPROVED PATIENT SAFETY OR NOT. SOME HOSPITALS HAVE SPENT A GREAT DEAL OF MONEY TO ASSIST WITH THEIR PATIENTS GETTING BETTER, SUCH AS PROGRAMS ASSITING WITH GETTING MEDICATIONS TIMELY, HOME HEALTH CARE COORDINATION, PATIENT EDUCATION, AND MORE. BUT, IT MAY BE THAT SOME HOSPITALS ARE RELUCTANT TO READMIT PATIENTS REQUIRING ADDITIONAL CARE DUE TO THE FINANCIAL RAMIFICATIONS TO FOLLOW LATER.

 

ONE STUDY TITLED “ASSOCIATION OF THE HOSPITAL READMISSIONS REDUCTION PROGRAM (HRRP)” CONCLUDED THAT IMPLEMENTATION OF THE HHRP WAS TEMPORALLY ASSOCIATED WITH A REDUCTION IN 30 DAY AND 1 YEAR READMISSIONS, BUT AN INCREASE IN 30 DAY AND 1 YEAR MORTALITY.  BUT A RECENT UPDATE FROM THE MEDICARE PAYMENT ADVISORY COMMISSION (MedPACK) WHICH HELPED FORMULATE THE PROGRAM FOR CONGRESS DISAGREES WITH THOSE FINDINGS.