Tag: hospitals
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.
Beginning Saturday, August 6, a federal law goes into effect requiring hospitals to tell their Medicare beneficiaries if they have not been formally admitted and why.
The NOTICE Act is a nationwide law which addresses complaints from Medicare patients who were surprised to learn that although they had spent a few days in the hospital, they were receiving observation care and were not admitted. Observation care is when patients are considered too sick to go home yet not sick enough to be admitted into the hospital.
Often, seniors are unaware they have not been admitted because they are getting treatment and, in some cases, staying in the hospital overnight, yet they are subject to higher charges than admitted patients and do not qualify for Medicare’s nursing home coverage.
The law states that starting August 6, “Medicare patients receive a form written in ‘plain language’ after 24 hours of observation care but no later than 36 hours.” The form must explain the reason a patient was not admitted and how that decision will affect Medicare’s payment for services and the patient’s costs. This information must be provided verbally to patients and a doctor or hospital staff must be available to answer any additional questions.
According to a Kaiser Health News analysis, claims for observation care have skyrocketed in recent years. Since 2006, the total number of claims has increased 91 percent, and long observation (stays of 48 hours or more) have increased by 450 percent.
“We are in complete agreement with the notion that the patient should certainly know their status and know it as early as possible,” said Sean Cavanaugh, Deputy Administrator at the Centers for Medicare and Medicaid Services, about the legislation.
However, some are worried that the law does not require hospitals to explain exactly why a patient is getting observation care instead of being admitted. Rep. Lloyd Doggett (D-Texas), who co-sponsored the bill, said that the plain language form does not comprehensively explain “the difference between Medicare’s Part A hospitalization and nursing home benefit and Part B, which covers outpatient services, including doctor’s visits, lab tests and hospital observation care.”
Also, a study by Brown University, which was published in Health Affairs, documents the increased use of observation status for Medicare beneficiaries, and notes that, “Although observation services are often appropriate, the extended use of such services could have unintended consequences for some Medicare beneficiaries by limiting access to skilled nursing care and subjecting them to higher out-of-pocket spending.”
While the goal of the new law is to educate beneficiaries, patients who are concerned about the potential costs associated with observation status, may elect to return home and leave the hospital against medical advice, which could be dangerous to their health.
Others, particularly medical professionals, believe another flaw is that the form does not sufficiently explain a doctor’s decision to either admit or provide a patient with observation care. This is a concern because if Medicare auditors find that hospitals erred by admitting patients who should have been in observation care, Medicare pays nothing, leaving patients to pay hospital and nursing home bills worth thousands of dollars.
Ultimately, once the NOTICE Act goes into effect, patients and their families should address hospital admission status vigilantly. The patient or the patient’s family must determine the hospitalization status as quickly as possible and challenge an observational placement if they think that the status is incorrect; waiting too long may mean an expensive bill.
To learn more about the NOTICE Act and how you can prepare for its implementation, 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.