Medicare fines 2,499 hospitals for high readmissions

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Federal government efforts to penalize hospitals for excessive patient readmissions end their first decade with Medicare cutting payments to nearly half of the country’s hospitals.

In its tenth annual penalty loop, Medicare is reducing payments to 2,499 hospitals, or 47% of all facilities. The average penalty is a 0.64% cut in payment for each Medicare patient stay from earlier this month through September 2022. Fines can be hefty, averaging $ 217,000 for a hospital in 2018, according to the Medicare Payment Advisory Commission (MedPAC) of the Congress. Medicare estimates the penalties will save the government $ 521 million over the next fiscal year. Thirty-nine hospitals received the maximum reduction of 3%, and 547 hospitals had so few returning patients that they did not escape punishment.

Another 2,216 hospitals are excluded from the program because they specialize in children, psychiatric patients or veterans. Rehabilitation and long-term hospitals are also excluded from the program, as are Critical Access Hospitals, which are treated differently because they are the only inpatient facility in an area. Of the 3,046 hospitals for which Medicare assessed readmission rates, 82% received a penalty, almost the same percentage as last year.

the Hospital Readmission Reduction Program (HRRP.)) was created by the Affordable Care Act of 2010 and began in October 2012 with the aim of encouraging hospitals to pay more attention to their patients after they are discharged. Readmissions were regular – for example, in 2008, nearly a quarter of Medicare heart failure patients ended up back in hospital within 30 days – and policy makers wanted to counter the financial incentives that hospitals had to get more business from these boomerang visits.

MedPAC found that readmission rates decreased from 2008 to 2017 after taking into account the general health of patients. The readmission rates of patients with heart failure decreased from 24.8% to 20.5%, the rates of patients with myocardial infarction decreased from 19.7% to 15.5%, and the rates of patients with pneumonia decreased from 20% to 15.8 % latest MedPAC analysis. The readmission rates for chronic obstructive pulmonary diseases, hip and knee joint replacements and diseases that are not prosecuted and punished in the criminal program also fell.

“The HRRP has successfully reduced readmission without affecting beneficiary mortality,” wrote MedPAC. The commission added that unraveling the exact causes of readmission rates was being made more difficult by changes in how hospitals record patient characteristics in Medicare billing and an increase in the number of outpatients. These factors made it difficult to determine the extent of the decline in the readmission rate due to the punitive program, MedPAC said.

Current penalties are calculated by tracking Medicare patients who were discharged between July 1, 2017 and December 1, 2019. Typically penalties are based on three patient years, but the Centers for Medicare & Medicaid Services have ruled out the past six months due to the chaos created by the pandemic as hospitals struggled to cope with an influx of Covid-19 patients.

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Reference: khn.org

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