Some Hospitals Affected by Federal Miscalculations on Medicare Readmissions

October 4, 2012
41 Views

 

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.

Related posts:

  1. Medicare Data Compare Acute Hospitals’ Readmission Rates Readmissions keep hospitals’ bottom lines in the black. It’s a…
  2. Critics Cry Foul at Unintended Shifts in Medicare Reimbursements to Hospitals The Agency for Healthcare Research & Quality figures in the…
  3. Some Maryland Hospitals Innovate with Their Own Brand of Care Coordination in Controlling Costs Medical necessity is a term that physicians once could claim…

You may be interested

What to Look for in Patient Solutions Software
eHealth
365 views
eHealth
365 views

What to Look for in Patient Solutions Software

Robert Cordray - August 17, 2017

The medical sector is one area where technology has had a significant impact, largely by providing tools that simplify many…

Can Natural Remedies Like RediCalm Decrease Stress and Anxiety?
Wellness
2 views
Wellness
2 views

Can Natural Remedies Like RediCalm Decrease Stress and Anxiety?

Ryan Kh - August 16, 2017

According to research from the National Institute of Mental Health, anxiety disorders are the most common mental illness in the…

How to Alleviate Stress Related Insomnia
Specialties
400 views
Specialties
400 views

How to Alleviate Stress Related Insomnia

JohnHenning - August 15, 2017

Do you have difficulty falling asleep or staying asleep every night? You aren't alone. According to multiple studies, including one…