CMS Dings 2,583 Hospitals in Penalties for Hospital Readmissions

More than 2,500 hospitals are feeling the heat as the Centers for Medicare and Medicaid Services (CMS) implement penalties for 30-day hospital readmissions. The Hospital Readmissions Reduction Program (HRRP), a component of the Affordable Care Act, tallies unplanned readmissions of Medicare patients for six conditions:

• Heart attack
• Chronic lung disease
• Pneumonia
• Heart failure
• Coronary artery bypass
• Hip or knee replacement

Most recently, CMS looked at hospital 30-day readmission data from July 1, 2015 through June 30, 2018 to assess penalties on payments made from October 1, 2019 through September 30, 2020. To do so, they reviewed national readmission averages for each condition. Fully 83 percent of the 3,129 hospitals evaluated were assessed a penalty, which will result in a combined $563 million loss.

Kaiser Health News analyzed the data and determined that 56 hospitals were assessed the maximum three percent penalty, meaning that they are being paid three percent less for each hospitalized Medicare patient in the current fiscal year. They included nine hospitals in Texas, five each in Pennsylvania and Florida, and four each in Oklahoma and Kentucky.

On the flip side, 179 hospitals that were penalized in 2019 lowered readmission rates to the extent that they are not being penalized this year. That figure includes 20 hospitals in California, 12 hospitals in Texas, 9 hospitals each in Indiana and Michigan, 8 each in Missouri and Pennsylvania, and 7 each in Illinois and Oregon.

Reducing Hospital Readmissions

Some studies have sought to determine the optimal framework for transitioning a patient from the hospital to the community in order to reduce readmissions. Components include discharge planning, patient education, post-discharge symptom management, and outpatient follow-up. Other researchers have identified factors that contribute to readmission, such as comorbidities, postoperative complications, and longer preoperative lengths of stay.

There are a number of reasons that preoperative length of stay can increase or a patient can be discharged too early, which can contribute to readmission within the first 30 days. Operationally, one way to support a patient being treated in a timely manner and discharged at an appropriate time is ensuring that physician schedules and physician contact information are accurate and accessible. When patient care is delayed due to an out-of-date schedule or call information, it can negatively impact patient outcomes. On the other hand, when up-to-the-minute physician schedules are accessible from mobile devices within or outside of the hospital, then delayed patient care and early discharge are less likely to occur, lowering the chances of readmission within the next 30 days.

When CMS takes a half-billion dollar bite out of hospital revenues, it’s time for facilities to think outside of the box. Compared to readmission penalties, the cost of cloud-based physician scheduling software is negligible.

MDsyncNET provides cloud-based physician scheduling that can be updated in real-time and accessed by authorized users from any internet-connected device. To learn more about how MDsyncNET’s physician scheduling solution can help you achieve your readmission metrics, call 888-506-5061.