New, tougher Medi­care read­mis­sion penal­ties take ef­fect Oct. 1

Modern Healthcare - - THE WEEK AHEAD - —Jaimy Lee

Hos­pi­tals face new fi­nan­cial penal­ties this week if they fail to pre­vent avoid­able read­mis­sions among Medi­care pa­tients.

Since Oc­to­ber 2012, hos­pi­tals have been pe­nal­ized when heart at­tack, heart fail­ure and pneu­mo­nia pa­tients re­turn to the hos­pi­tal within 30 days. Start­ing Wed­nes­day, that fine goes up to 3%, from the 1% penalty in­curred when the pro­gram started. In ad­di­tion, un­planned read­mis­sions for pa­tients who re­ceived a to­tal hip or knee re­place­ment or have chronic ob­struc­tive pul­monary dis­ease will trig­ger penal­ties for the first time. The read­mis­sion penal­ties have been cred­ited with help­ing keep Medi­care cost growth at his­toric lows.

“More hos­pi­tals are get­ting pe­nal­ized and more hos­pi­tals are get­ting big­ger penal­ties,” said Hiten Pa­tel, man­ag­ing di­rec­tor at The Ad­vi­sory Board Company.

There is lit­tle pub­lished re­search on what hos­pi­tals and physi­cians can do to pre­vent read­mis­sions for COPD pa­tients, said Dr. Anne Dixon, di­rec­tor of pul­monary and crit­i­cal-care medicine at Fletcher Allen Health Care in Burling­ton, Vt.

To pre­vent such read­mis­sions, Fletcher Allen is de­vel­op­ing a path­way to treat COPD pa­tients, who make up about 8% of the sys­tem’s adult pa­tients. The sys­tem’s elec­tronic health records have been mod­i­fied to re­mind clin­i­cians that COPD pa­tients should get flu shots and par­tic­i­pate in smoking-ces­sa­tion pro­grams.

Still, some ex­perts say hos­pi­tals fare bet­ter in pre­vent­ing read­mis­sions when they fo­cus on im­prov­ing pa­tient care over­all rather than tar­get­ing spe­cific con­di­tions, and when they strive to make im­me­di­ate post-dis­charge pro­ce­dures safer.


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