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[By Dr. David Edward Marcinko MBA CMP™]

As our physician readers are aware, beginning in 2013, CMS will penalize hospitals for excess readmission rates.

Initial focus will be on readmissions for heart failure, acute myocardial infarction and pneumonia — data that is already reported on the CMS Hospital Compare web site, as previously noted on this ME-P forum.

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As private payers follow CMS’s reimbursement and reporting leads, healthcare organizations must take bold steps to reduce avoidable readmissions.

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5 Responses

  1. 1 in 3 adults discharged from hospitals does not see doc within 30 days

    Dr. Marcinko – Perhaps the reason for re-admissions can partially be explained in this post.

    http://www.healthpolicyreview.org/daily_review/2011/12/study-1-in-3-adults-discharged-from-hospitals-does-not-see-doc-within-30-days.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+typepad%2Fhealthpolicyreview+%28Ohio+Health+Policy+Review%29

    Dr. MB Clinton-Weil

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  2. ReAdmissions

    As far as I know there are no quality metrics that measure a non-admission (a person who should have been admitted but wasn’t), so there aren’t financial penalties for withholding care – despite the efforts of the “pay for quality” advocates.

    Dr. David Edward Marcinko MBA CMP™

    Like

  3. UPMC: 5 Medical Conditions With the Highest Readmissions in 2013

    1. Sepsis (12%)
    2. Heart failure (6.7%)
    3. Pneumonia (5.0%)
    4. COPD (4.6%)
    5. Heart attack (1.3%)

    Source: Forbes

    Like

  4. Avoidable Admissions are 4x Higher for Lowest-Wage Employees

    Health Affairs recently published an article on employee health spending relative to income level. Here are some key findings from the report:

    • Annual healthcare spending per patient was $4,835 for the lowest-wage group.
    • 19% in the lowest-wage group used preventive care, versus 38% in the highest.
    • Lowest-wage employees had 31 hospital admissions per 1,000 versus 17/1,000.
    • Low earners had 4x the rate of avoidable admissions (4.3/1,000 vs. 0.9/1,000).
    • ER visits were 3x higher for lowest-wage employees (370/1,000 vs. 120/1,000).
    • Annual healthcare spending per patient was $5,074 for the highest-wage group.

    Source: Health Affairs, February 2017

    Like

  5. 4 in 5 Hospitals Will Be Penalized For Readmissions This Year

    Kaiser Health News recently released an article on hospital readmissions penalties. Here are some key findings:

    • Medicare penalized 4 out of 5 hospitals for excessive readmissions this year.
    • The average penalty is 0.73% of each payment between Oct. 1 – Sept. 30, 2018.
    • 48 hospitals received the maximum punishment of a 3 percent reduction.
    • More than 1,500 hospitals were exempted from penalties this year as required by law.
    • The government projects to save $564 million due to readmissions penalties.
    • 90%+ of hospitals will be punished in AZ, CT, FL, KY, MA, MN, NJ, NY and VA.

    Source: Kaiser Health News

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