While readmission rates are dropping at many hospitals, Medicare fined 2,610 hospitals across the nation for readmitting patients within a month of being discharged, with regulators hitting 39 of those facilities with the largest possible penalty on October 1, 2014.
Some so-called “safety-net” hospitals received the stiffest penalties. The fines have prompted concerns that hospitals serving poor populations could be disproportionately impacted by readmission penalties and have fueled debate about whether the Centers for Medicare and Medicaid Services (CMS) readmission rules should be reexamined.
Kaiser Health News (KHS) reports that some penalties are as small as a hundredth of a percent, and that hospitals with the highest readmission rates are losing three percent of each payment, an increase from the maximum punishment of two percent last year. The increase brings the top penalties, which will affect Medicare reimbursements through September 30, 2015, to the full force authorized by the federal health law.
Instated three years ago in October, the penalties are intended to prompt hospitals to pay closer attention to what happens to patients after they leave facilities. KHS reports that hospitals nationwide have responded to the Hospital Readmissions Reduction Program by replacing routine discharge plans with more active efforts like assigning physicians to monitor patient recoveries or giving medications to patients who can’t afford them.
RealTime Medicare Data (RTMD) offers a service called the RealTime Readmission Report so that hospitals can accurately quantify a facility’s dependency on readmissions and determine how to target and manage readmission populations.
“Being able to access readmission numbers helps a hospital adjust and reduce readmissions across the continuum of care,” said RTMD CEO Eugenia McWilliams. “Using the data, a hospital can reduce the chances of receiving costly penalties from CMS.”
Access to data, along with procedural changes, can help hospital administrators reduce anxieties about too many readmissions.
Safety-net hospitals may continue to struggle
Modern Healthcare says there is concern that hospitals in poor areas will continue experiencing high readmission rates and be subjected to excessive penalties from Medicare. Why? Several studies indicate that the Readmissions Reduction Program does not consider socio-economic conditions when evaluating the number of hospital readmissions, the article explains.
Consequently, some argue the Readmissions Reduction Program may need to be reevaluated. The Joint Commission Journal on Quality and Patient Safety published an analysis of eight safety-net hospitals. Community conditions such as scarce resources, a variety of patient needs, limited ability to influence care in the community, and a misalignment of financial incentives can cause increased readmission rates.
The state of Kentucky exemplifies these concerns. Nine of the 39 hospitals receiving the maximum penalty are in Kentucky. Forty counties in Kentucky are considered to have “persistent poverty,” meaning 20 percent or more of their residents have fallen below the poverty line over the past three decades, according to the U.S. Census Bureau’s American Community Survey.
Seven of the nine Kentucky hospitals that received the maximum fine were in persistent-poverty counties, and three received the maximum fine all three years.
“Sometimes the safer thing, and the higher quality of care might be to be readmitted,” Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine told Modern Healthcare. “But with significant penalties, the incentive is to do the opposite.”