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Report: Financial penalties prove effective against readmissions

Based on data collected from more than 2,800 hospitals, researchers were able to prove the effectiveness of the Hospital Readmission Reduction Program (HRRP). Harvard and Beth Israel Deaconess Medical Center researchers added that facilities that were penalized the most saw the greatest improvement in readmission reduction. Nearly $1 billion in penalties have been imposed so far.

“It’s a quite clear example that when hospitals are reimbursed, not just for how much they do but how well they do it, it makes an impact on their behavior,” study co-senior author Robert W. Yeh, MD, told HealthLeaders. “That is what you would expect from an individual and this seems to incentivize organizations to act collectively to move in the same direction.”Money

Researchers looked at 30-day readmission rates for patients with acute myocardial infarction (AMI), congestive heart failure, or pneumonia. In January 2008, the readmission rates at penalized institutions were 21.9% for AMI, 27.5% for heart failure, 20.1% for pneumonia, compared to 18.7%, 24.2%, 17.4%, at non-penalized facilities. However, once HRRP was announced in March 2010, rehospitalization rates declined notably faster at penalized hospitals. Compared to non-penalized facilities, penalized hospitals decreased their AMI readmissions by 1.24%,  1.25% for heart failure, and 1.37% for pneumonia.

For a full interview with the researchers, visit HealthLeaders Media.

CMS: Hospital readmission rate drop nationwide

Between 2010 and 2015, hospital readmission rates have dropped an average of 8% nationally, with 100,000 unnecessary patient readmissions avoided in 2015 alone. CMS reported the news on its blog, stating that 49 states and the District of Columbia have seen reductions in avoidable 30-day readmissions of Medicare patients over the past five years.

Readmissions reduction has been a major goal for CMS, with an estimated $17 billion in Medicare spending spent annually on avoidable hospital readmissions.  The agency also announced that it would be increasing its fines for high readmission rates in fiscal 2017. While hospitals may look to this new data as a sign of hope, a study in The New England Journal of Medicine  cautions that the continuing the drop may not be possible.

“Presumably, hospitals made substantial changes during the study period but could not sustain such a high rate of reductions in the long term,” the authors wrote. [more]

Study: Readmissions sometimes improve patient health

Are readmissions always bad? A new study by John Hopkins Medicine published in The Journal of Hospital Medicine says the answer is not as clear cut as once believed. Researchers looked at three years and 4,500 acute-care facilities worth of readmission and mortality data, finding that hospitals with high readmission rates tended to have lower mortality rates as well.

The study focused on the six conditions that CMS penalizes hospitals for in its readmissions reduction program: heart attack, pneumonia, heart failure, stroke, chronic obstructive pulmonary disease (COPD), and coronary artery bypass. In particular, high readmission rates seemed to correlate with better mortality rates for COPD, heart failure, and stroke.

“But using readmission rates as a measure of hospital quality is inherently problematic,” study author Daniel J. Brotman, MD, said in a press release. “High readmission rates could stem from the legitimate need to care for chronically ill patients in high-intensity settings.”

This especially applies to cases of medically fragile patients who may need that follow up care to stay alive, he said. Readmission rates are currently used in CMS’s hospital star ratings system and the agency financially penalizes hospitals that have high readmission rates.

Brotman said it’s “particularly problematic” that the star rating system applies equal weight to readmissions and mortality, saying that it unfairly skews the data against hospitals. While some readmissions are the result of preventable issues such as bad handoffs, he added, there are times when readmission results from serious disease and patient frailty.

“It’s possible that global efforts to keep patients out of the hospital might, in some instances, place patients at risk by delaying necessary acute care,” said Brotman.

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CMS to save millions by increasing hospital readmission fines

CMS LogoWith spending on inpatient hospital services expected to increase by $746 million next year, CMS is in need of new ways to save and raise revenue. On August 2, the agency announced a change that will help ease some of its money woes.

At the beginning of the 2017 fiscal year in October, CMS will add new criteria to the Hospital Readmissions Reduction Program that’s expected to save CMS $538 million; $108 million over the previous fiscal year. The new criteria will increase the number of hospitals that are penalized for high readmission rates, as well as the amount for which they are penalized.

CMS has added coronary artery bypass grafts as a surgery for which hospitals can receive a readmission penalty, as well as alter how it calculates readmissions for pneumonia. Other readmission penalty procedures include heart failure, heart attacks, chronic obstructive pulmonary disease, and hip and knee replacements. It’s estimated that 2,588 hospitals will be fined next year due to the update, losing 0.73% of their Medicare payments on average. Only 49 hospitals are expected to receive the maximum penalty of 3% according toKaiser Health News.

Readmissions have been a major point of contention between hospital groups and CMS. Many argue that since CMS’ program doesn’t take socioeconomic factors into account, hospitals that serve poorer or sicker patients are disproportionately fined for high readmissions.

“We are disappointed CMS missed another opportunity to adjust for the social and economic challenges of vulnerable patients in its quality improvement and reporting programs,” said Beth Feldpush, senior vice president at America’s Essential Hospitals, in a statement. “The evidence is clear that these programs disproportionately penalize hospitals that serve disadvantaged patients and communities.”

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