News Feature | November 5, 2013

Are Readmission Fines Working?

Source: Health IT Outcomes
Katie Wike

By Katie Wike, contributing writer

Top Federal IT Initiatives Include Security, Disaster Recovery, Digitizing Records

The American College of Surgeons disagrees with CMS’s view that readmission penalties motivate providers to achieve better standards of care

According to HealthIT Analytics, since the Hospital Readmissions Reduction Program (HRRP) started in 2012, hospitals have been penalized more than $500 million for readmitting patients within 30 days of discharge, including nearly 20 percent of Medicare patients. About two-thirds of hospitals nationwide have paid fines to the HRRP.

Despite provider protests that the penalties aren’t working, HealthIT Analytics reports, “Hospitals paid out $53 million less in the second year of HRRP than they did in the first, and an emphasis on using EHR data analytics, predictive risk scores, and more comprehensive population management techniques seem to be paying off.”

Many providers, however, are still unhappy about being punished for circumstances often out of their control. The American College of Surgeons argued in a letter to CMS in June, “Outcomes for chronic illnesses can vary widely, resulting in potentially unfairly penalizing hospitals and physicians for readmissions that are not under their control.” And since inner city populations that often have lower education and income levels have high rates of chronic diseases, increasing fines for these kinds of readmissions “could result in hospitals that care for high-risk populations being inadvertently targeted or incentivized to limit access to care to such high-risk patients.”

The ACS continues, “Another unintended consequence would be penalizing hospitals that care for the highest acuity Medicare patients and the potential that these hospitals will decrease their care for such patients, thereby creating an access issue. As such, these other drivers of readmission and mortality should be taken into consideration in the risk adjustment process. In addition, readmission measures should exclude readmissions for conditions that are unrelated to the original admission, such as ‘readmission’ due to traumatic injury.”

Even more concerning is that a recent study by the University of Michigan Health System that found readmissions data itself may be misleading. EHR Intelligence reports that while health systems are aware how many patients are readmitted to their facilities, they do not have data on patients who are admitted at one hospital then readmitted to another.

“As it currently stands, CMS sends institutions annual hospital-specific reports,” study co-author Andrew Gonzalez, MD, JD, MPH says. “These reports include the institution’s all-hospital readmission rate, and, moreover, the provider IDs for all the other hospitals to which an institution’s patients were readmitted.  Yet upon receipt, the information is already a year old. The incorporation of real-time data might significantly improve the efficiency of the quality improvement cycle.”

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