Medicare hospital readmissions reduction program

Risk Adjustment Has Impact on Medicare Readmissions Program

The use of social risk adjustment has helped reduce differences in the penalties assessed to safety-net hospitals and other hospitals by Medicare’s hospital readmissions reduction program, according to a new study. According to the study published in the journal Health Affairs, Seven studies found that adding social risk factors to the program’s base risk-adjustment model (which adjusts only for age, sex, and comorbidities) reduced differences in risk-adjusted readmissions and penalties between safety-net hospitals and other hospitals. Three studies found that peer grouping, the HRRP’s current approach to social risk adjustment, reduced penalties among safety-net hospitals. Two studies found that differences [...]

admin2022-09-22T06:00:18+00:00September 22, 2022|Medicare, Medicare reimbursement policy|

Hospital Readmissions Tied to Local Medical Resources?

Communities with more primary care doctors and more nursing home beds experience fewer avoidable hospital readmissions, according to a new study. At the same time, communities with more nurse practitioners and more home health agencies experience a high rate of hospital readmissions. In addition to the significance this may have for the welfare of the residents of individual communities, such a finding also may have implications for Medicare’s hospital readmissions reduction program, which penalizes hospitals that have “too many” readmissions for selected medical problems. If the availability of certain community resources has a meaningful impact on readmissions it may be [...]

admin2022-07-07T13:34:05+00:00July 7, 2022|Medicare|

Nearly Half of Hospitals Nicked for Readmissions

Medicare’s Hospital Readmissions Reduction program will penalize 2499 hospitals for excessive readmissions in the coming year. That represents 47 percent of all hospitals covered by the program. The average penalty for the nearly 2500 hospitals will be a 0.64 percent reduction of their Medicare payments. Thirty-nine hospitals will suffer the maximum penalty: a three percent cut of their Medicare payments. Learn more about the effect the Hospital Readmissions Reduction Program has had on hospitals – and on patients admitted to the hospital with specific medical conditions – in the Kaiser Health News story “Medicare Punishes 2,499 Hospitals for High Readmissions.”

admin2021-11-01T06:00:12+00:00November 1, 2021|Medicare|

Most Hospitals Fined by Medicare Over Readmissions

More than 80 percent of all hospitals subject to Medicare’s hospital readmissions reduction program, and half of all of hospitals in the country, will be penalized in FY 2021 under that program because they have what Medicare considers to be too many avoidable readmissions. In all, 2556 of the 3080 hospitals subject to the program will be penalized. More than 600 will see their inpatient payments cut one percent as a result and the average cut will be 0.69 percent. The penalties are based on hospital performance with patients experiencing congestive heart failure, heart attacks, chronic obstructive pulmonary disease, coronary [...]

admin2020-11-06T06:00:25+00:00November 6, 2020|Medicare regulations, Medicare reimbursement policy|

Feds Penalizing Wrong Hospitals for Readmissions, Study Finds

Medicare’s hospital readmissions reduction program often penalizes the wrong hospitals for excessive readmissions. Or so concludes a new study published in the journal JAMA Cardiology. According to the study, …the percentage of hospitals that were incorrectly penalized was 10.1% for acute myocardial infarction, 10.9% for heart failure, and 12.3 percent for pneumonia. The study also found that the readmissions reduction program is failing to penalize some hospitals that do deserve penalties based on the program’s standards, writing that …in fiscal year 2019, the percentage of hospitals that should have been penalized by the program, but were not, was 20.9% for [...]

admin2020-10-20T06:00:30+00:00October 20, 2020|Medicare, Medicare reimbursement policy|

Most Hospitals Hit With Medicare Readmissions Penalties

Nearly 2600 hospitals will be penalized by Medicare in FY 2020 for excessive patient readmissions under Medicare’s hospital readmissions reduction program, according to the Centers for Medicare & Medicaid Services. In all, 83 percent of hospitals covered by the program will be penalized, forfeiting up to three percent of their Medicare payments with an average penalty of 0.71 percent of those payments. The cumulative penalties for these hospitals will amount to $563 million in FY 2020. In all, 1177 hospitals will be penalized more than they were last year and 1148 will be penalized less. 56 hospitals will be assessed [...]

admin2019-10-08T06:00:52+00:00October 8, 2019|Medicare, Medicare reimbursement policy|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s September agenda were: context for Medicare payment policy the effects of Medicare Advantage “spillover” on Medicare fee-for-service spending and coding evaluation of the hospital readmissions reduction program examining the effects of competitive bidding for diabetes testing supplies and improving payment policies for DMEPOS products excluded from competitive bidding a value incentive program for post-acute-care providers Medicare indirect medical education (IME) policy, concerns, and considerations for revising MedPAC is an independent congressional agency that advises Congress on issues [...]

admin2019-09-12T09:50:13+00:00September 12, 2019|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

Readmissions Program Changes Produce New Outcomes

Many hospitals are faring better under Medicare’s hospital readmissions reduction program since changes in that program were implemented earlier this fiscal year. According to a new study, safety-net, academic, and rural hospitals have enjoyed improved performance under the program since Medicare began organizing hospitals into peer groups based on the proportion of low-income patients they serve rather than simply comparing individual hospital performance to that of all other hospitals. While the current fiscal year is still under way, it appears that safety-net hospitals will enjoy a collective decline of $22 million in Medicare readmissions penalties while 44.1 percent of teaching [...]

admin2019-04-26T06:00:35+00:00April 26, 2019|Medicare, Medicare regulations, Medicare reimbursement policy|

Mixed Verdict: Home Health Leads to More Readmissions But Lower Costs

Readmission rates are greater for patients discharged from hospitals to home health care than they are for those discharged to skilled nursing facilities but home health services cost so much less than nursing homes that home health saves money even with the higher numbers of hospital readmissions. This is one of the major findings of a new study comparing differences in outcomes for patients who are admitted to skilled nursing facilities upon discharge from the hospital to those for patients who go direct home and receive home health services. The study also found no meaningful differences in patient mortality or [...]

admin2019-03-22T06:00:57+00:00March 22, 2019|Alternative payment models, hospitals, Medicare, Medicare post-acute care, Medicare reimbursement policy|

Readmissions Reduction Program Results Overstated?

A new study suggests that the encouraging results of Medicare’s hospital readmissions reduction program may not actually be as encouraging as people thought. According to a new study published in the journal Health Affairs, data on reduced readmissions may be more the result of changes in hospital coding practices than improved quality performance by hospitals. The report suggests that new industry standards for reporting were implemented at roughly the same time Medicare launched the value-based purchasing program and may account for most or even all of the reported improved performance by hospitals. Learn more from the Health Affairs study “Decreases [...]

admin2019-01-14T06:00:42+00:00January 14, 2019|Medicare, Medicare reimbursement policy|