By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: 2015 Means an Increase in Medicare Penalties for Readmissions
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Finance > 2015 Means an Increase in Medicare Penalties for Readmissions
BusinessFinanceHealth ReformHospital AdministrationPolicy & LawPublic Health

2015 Means an Increase in Medicare Penalties for Readmissions

Abby Norman
Abby Norman
Share
7 Min Read
SHARE

Medicare Penalties Rising

Hospital Readmissions penalized

Contents
  • Medicare Penalties Rising
  • Medicare Penalties Rising
  • Rising Healthcare Costs Equal Long Term Economic Vulnerability
  • Are We Lowering Costs — Or Shifting The Burden?
  • Why Are Patients Readmitted?
  • The “Lost To Follow-Up” Dilemma
  • Economic Recession Also To Blame
  • 3% Penalty — 2015 Not The Year To Start Having A Readmission Problem

Medicare Penalties Rising

Hospital Readmissions penalized

For the third year in a row, Medicare will be increasing the percent penalty for hospitals who have high readmission rates: up now to 3% in 2015. Despite efforts through the ACA and readmission reductions programs, the rate of readmissions continues to rise.

Initially, Medicare attempted to stifle this by forcing hospitals to be transparent about their numbers. By making the number of readmissions public, the hope was that there would be a certain accountability and hospitals would then attempt to discern why their rates were so high.

More Read

The Cost of Quality Medical Supplies
Diabetes Innovation: Managing Chronic Disease with Primary Care
DeathWise.org – DIY End of Life Planning
Big Names Changing the Future of Personalized Patient Care
The Supreme Court Upholds the ACA, with a Caveat About the Medicaid Expansion

When this didn’t prove to drop the rates as much as Medicare would have hoped, they tacked on a financial penalty that hospitals would need to pay if their rates continued to rise.

Rising Healthcare Costs Equal Long Term Economic Vulnerability

On the whole, rising costs of healthcare are contributing to the long term vulnerability of the U.S. economy. Particularly because $17 billion of the $26 billion annual dollars spent on readmissions has been deemed preventable by CMS. Last year alone Medicare fined 2,610 hospitals for high readmission rates. 721 hospitals, additionally, were fined a 1% reduction in their Medicare payments due to Hospital Acquired Infections — resulting in $373 million in spending.

As these trends continue to drift upwards, developing sustainable and dynamic ways to keep costs down without negatively impacting care quality has been, and is likely to continue to be, the primary focus of today’s healthcare leaders.

Are We Lowering Costs — Or Shifting The Burden?

One major concern, however, is that in their attempt to lower cost the cost will be, instead, shifted to the consumer. The concerns about “cost-shifting” are real and, considering that the other quarter of healthcare spending is made up of rising co payments and deductibles, one that may not be far off.

Statistically, 1 in 5 elderly patients will be readmitted within 30 days of discharge. Whenever a patient is readmitted, the cost of their care nearly doubles. But why are these patients landing back in the hospital in the first place?

Why Are Patients Readmitted?

More often than not, patients are readmitted due to a combination of factors relating not necessarily to their treatment while they are in the hospital, but what happens post-discharge. Or, as the case may be — what doesn’t happen.

When a patient is within 48 hours of discharge, one of the healthcare provider’s top priorities is medication reconciliation. While electronic health records can be helpful in reminding not just nurses, but doctors, of the importance of making sure a patient’s prescriptions are reviewed — and inactive medications removed from the record—the teaching involved in “med rec” is perhaps the most valuable aspect to the patient, and may be the key to reducing the likelihood they will be readmitted. When a patient is sent home, even if caregivers are present during their recovery, issues or confusion regarding their medication regimes can walk a very fine line between an inconvenience — and a fatality.

The “Lost To Follow-Up” Dilemma

In the same vein, even if patients haven’t necessarily had any changes in their medication regime, they are sometimes simply “lost to follow-up” post-discharge. Meaning that, once they leave the hospital, they are not followed up with in their primary care physician’s office or, by a nurse at the hospital by phone. These follow-ups are crucial, as often times patients are readmitted through the emergency room when they’ve come seeking treatment for a perceived complication, or, having encountered a post-operative situation that they and their families felt ill-equipped to handle.

Of course, if such is the case and a patient is able to follow-up with their primary care doctor this is ideal, but if a patient — and their hospital chart — is lost in the fray it’s possible that their regular doctor’s office may not have even realized they were hospitalized. This is becoming far less frequent an occurrence with the advent of the electronic medical record, but it does still happen. It exemplifies why a pointed effort must be made by hospital staff to establish follow-up procedure for patients.

Economic Recession Also To Blame

Of course, this uptick in spending isn’t entirely attributable to readmissions: the other major factor that hospitals and patients have to consider is the economic recession’s impact on healthcare dollars. With many patients unable to purchase private insurance, in part because of the rising deductibles and co payments previously mentioned, there is a greater dependence on government programs through Medicare and Medicaid — which we’ve seen reflected somewhat in Obamacare enrollments, though the program is still more or less in its infancy, so the long term economic impact hasn’t been definitively assessed.

3% Penalty — 2015 Not The Year To Start Having A Readmission Problem

In any case, with this year’s Medicare reduction in payment topping out at 3%, it’s in the best interest of hospitals nationwide to evaluate key metrics related to their readmission rates. Even if they haven’t previously had trouble with these numbers, given the amount of money they stand to lose, this wouldn’t be the year to be lax on their analysis.

Share This Article
Facebook Copy Link Print
Share
By Abby Norman
My name is Abby Norman and I am a healthcare blogger. With over 10 years of experience in the medical field, I have developed a passion for helping others understand the complexities of healthcare.

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

dental care
Importance of Good Dental Care for Health and Confidence
Dental health Specialties
October 2, 2025
AI in Healthcare
AI in Healthcare: Technology is Transforming the Global Landscape
Global Healthcare Policy & Law Technology
October 1, 2025
Choosing the Right Swimwear for Health and Safety
News
September 30, 2025
sports concussions
Concussion In Sports: How Common They Are And What You Need To Know
Infographics
September 28, 2025

You Might also Like

Is Your Doctor a God or a Guide?

October 4, 2011

Hoag Hospital Using daVinci Robot for Gynecologic Surgery Procedures

September 13, 2011

Medicare? I’m Sorry, the Doctor Won’t See You Now

August 15, 2013

From Millennials to Seniors: How to Meet Diverse Digital Demands in Healthcare

March 23, 2015
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?