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Created by the Affordable Care Act, the program evaluates the frequency with which Medicare patients at most hospitals return within 30 days and lowers future payments to hospitals that had a greater-than-expected rate of return. The pandemic threw hospitals into turmoil, inundating them with covid patients while forcing many to postpone elective surgeries for months.
CMS also excluded from its calculations Medicare patients who were readmitted with pneumonia across all three years because of the difficulty in distinguishing them from patients with covid. Akin Demehin, senior director of quality and patient safety policy at the American Hospital Association, said the changes were warranted. As a result of its analysis, CMS penalized 2, hospitals, the fewest since the fiscal year that ended in September , a KHN analysis found.
The average payment reduction was 0. The reductions will be applied to each Medicare payment to the affected hospitals from Oct. Some hospitals will see their penalties greatly reduced from last year.
The penalty on St. To limit penalties, many hospitals in recent years have instituted new strategies to keep former patients from needing a return visit. Robert Coates, interim chief medical officer at Hunterdon Health, which owns Hunterdon Medical Center, said in a statement that the hospital set up a system to identify patients who visited the emergency room within 30 days of a hospital stay.
Hunterdon also calls all discharged patients to ensure they have filled their prescriptions and had a follow-up visit with a clinician within a week of leaving the hospital. Jessica Satterfield, director of quality and clinical excellence at St.
Of the unpenalized, all but were automatically exempted. The 2, exempted hospitals include those that specialize in children, psychiatric patients, or veterans. Rehabilitation and long-term care hospitals are also excluded from the program, as are critical access hospitals, which Medicare pays differently to help them stay open in areas with no other hospitals. Although the penalties imposed by the HRRP are measurable, the short- and long-term consequences and opportunity cost of taking resources away from resource-constrained hospitals will not be.
Beyond concerns about the inequitable effects of the HRRP, front-line clinicians have also worried that incentives to avoid readmissions may lead to potentially inappropriate management of higher-risk patients with chronic conditions, such as heart failure, in the outpatient rather than inpatient setting.
Although the evidence is mixed, several independent investigations have substantiated these concerns, showing that mortality within 30 days of discharge for heart failure increased under the HRRP compared with earlier trends. Nonetheless, the bar for evidence suggesting that a policy is harmful should not be higher than the bar suggesting benefit, and therefore, any signal that suggests potential harm should be evaluated and addressed.
More than a decade has passed since the HRRP was implemented. At best, the evidence to date suggests that the HRRP has had no meaningful effect on the rate at which patients return to the hospital within 30 days of discharge. At worst, the HRRP has unfairly penalized hospitals caring for the most vulnerable populations in our country and potentially resulted in patient harm. How much more evidence will it take for policy makers to officially end this program? The persistence of the HRRP is perhaps emblematic of the growing tension between front-line clinicians who face the effects of value-based policies and federal decision-makers who may not, but ultimately dictate their development and implementation.
If policy makers are serious about enhancing patient care, they have a responsibility to iteratively improve, refine, or eliminate policies based on emerging evidence and take concerns raised by front-line clinicians seriously. After a decade of evidence that has overwhelmingly shown that the HRRP has been largely ineffective, it is time for federal policy makers to retire the program. Published: November 17, Corresponding Author: Jose F.
Twitter Facebook. This Issue. Views 1, View Metrics. Invited Commentary. November 17, Jose F. Original Investigation. Amber K. Back to top Article Information. Readmissions, observation, and the hospital readmissions reduction program. Association of coded severity with readmission reduction after the Hospital Readmissions Reduction Program.
Hospital revisits within 30 days after discharge for medical conditions targeted by the Hospital Readmissions Reduction Program in the United States: national retrospective analysis. Get the latest research based on your areas of interest. Weekly Email. Monthly Email. Save Preferences.
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WebOct 12, · The Mapping Medicare disparities tool is composed of an interactive visualization driven through drop-down menus which follow this section. Users seeking . Centers for Medicare & Medicaid Services, HHS § (4) Readmission to a composite distinct part. When the nursing facility to which a resident is readmitted is a composite distinct . Conditions that resulted in the most readmissions for Medicaid patients, For Medicaid patients aged 18 to 64 years (Table 3), the 10 conditions with the most all-cause, day .