Some Hospitals Affected by Federal Miscalculations on Medicare Readmissions

CMS is taking a fresh look at participating hospitals’ readmission rates. Back in ’10, the Hospital Readmission Reduction Program was created as part of the ACA to decrease the overwhelming number of readmissions within 30 days’ time for certain key diagnoses. Originally, certain hospitals were reimbursed at higher rates based upon initial data. However, recently, CMS noticed errors in calculating payment pentalties to hospitals with higher rates.

CMS is taking a fresh look at participating hospitals’ readmission rates. Back in ’10, the Hospital Readmission Reduction Program was created as part of the ACA to decrease the overwhelming number of readmissions within 30 days’ time for certain key diagnoses. Originally, certain hospitals were reimbursed at higher rates based upon initial data. However, recently, CMS noticed errors in calculating payment pentalties to hospitals with higher rates.

Because of this error (which involved including claims data from earlier than planned), a handful of acute hospitals will lose more money than was originally calculated. Naturally, the affected facilities are a more than a little concerned about it. The initiative to cut down on costs associated with frequent readmits is a mixed blessing for hospitals under the ACA. On one hand, they are supposed to be rewarded for doing the right thing by arbitrary federal standards. That financial benefit, however, is questioned by many lawmakers and hospital administrators as being unduly regulatory. Basing those concerns on data that show little benefit in clinical patient outcomes (as opposed to costs of care), some administrators claim the possibility of losing out with more empty beds and operating burden.

Everyone should agree that the government needs to become more streamlined with respect to healthcare spending in this arena. Hospitals do not have be scapegoated in the drive toward reform. Other than mandating increased adherence to treatment protocols and cursory attempts better discharge planning, perhaps hospitals should be forming partnership networks, as this piece discusses, in an effort to apply appropriate care at the appropriate times. Waiting until the patient is discharged — as long as he or she is not readmitted within 30 days — to be rewarded for care delivery, while effectively ceding responsibility until the next admission (hopefully after 30 days) — is not the manner in which to approach this problem.

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