Tag: federal fines
More than half of the nation’s hospitals –a total of 2,597—will be facing record fines once the federal government’s new readmission penalties go into effect in the next two months.
Beginning October 1, hospitals having more patients than expected return within a 30-day period will be subject to record-high penalties. The penalties are based on the readmission rate for patients with six conditions: heart attacks, heart failure, pneumonia, chronic lung disease, hip and knee replacements and — for the first time this year — coronary artery bypass surgery.
While the same number of hospitals as last year will face penalty, the fines will increase by a 20 percent, as Medicare withholds more than half a billion dollars in payments over the next year. According to Medicare, the penalties are expected to total $528 million, about $108 million more than last year.
Proponents of the Hospital Readmissions Reduction Program (HRRP), which began in 2012, believe that these higher penalties will help hospitals identify best practices and develop a quality-improvement infrastructure that will address readmissions in the context of other priorities. Research conducted by the Centers for Medicare and Medicaid Services (CMS) supports this notion. Data shows that national readmission rates have dropped as many hospitals pay more attention to how patients fare after their release.
However, there are others who oppose these penalties because of the challenges faced by hospitals that treat large numbers of low-income patients. They argue that these patients may have recuperating because they can’t afford their medications or lack the social support to follow physician instructions.
The American Hospital Association published a report asking several physicians for their reactions to the HRRP. Doctors Karen E. Joynt, M.D., M.P.H., and Ashish K. Jha, M.D., M.P.H. candidly disclosed that “the growing body of evidence suggests that the primary drivers of variability in 30-day readmission rates are the composition of a hospital’s patient population and the resources of the community in which it is located—factors that are difficult for hospitals to change.”
Despite the continued debate, hospitals with more unplanned readmissions than expected will receive a reduction in each Medicare case reimbursement for the upcoming fiscal year, which runs from October 1 through September 2017. These payment cuts apply to all Medicare patients, not just those with one of the six conditions Medicare measured for readmission.
According to Kaiser Health News (KHN), starting in October, more than 2,500 hospitals will receive lower payments for every Medicare patient that stays in the hospital. “The average Medicare payment reduction is 0.61 percent per patient stay, but 38 hospitals will receive the maximum cut of 3 percent. A total of 506 hospitals, including those facing the maximum penalty, will lose 1 percent of their Medicare payments or more,” KHN reported.
It’s important to note that under the Affordable Care Act, a variety of hospitals are excluded from readmission penalties, including those serving veterans, children, and psychiatric patients. Despite the more than 1,400 hospitals exempt from these fines, KHN determined that 1,621 hospitals have been penalized in each of the five years of the program.
To learn more about the Hospital Re-admissions Reduction Program (HRRP) and its impact on you or your loved one, visit My Medicare Planner and contact Tom Chamouris. Tom and his staff are committed to protecting senior citizens and helping them navigate through the “Medicare maze”—at no additional cost. See our ad on page 1 of Boomer magazine.