It might be something that occurred in the care of another provider, or it might have something to do with the patient, through no cause of their own, or they didn't comply with care requirements, whether it was their diet or they failed to take a certain drug."
Smith emphasizes that the MHA "is not saying that hospitals can't reduce readmissions. What we're saying is that we need a more discriminating way of looking at this."
"It is therefore inexplicable and inexcusable for MassHealth to ignore the opinion of experts and to proceed with its potentially preventable readmission policy," the letter to Harris said.
Gens emphasized that many hospitals in the state are suffering already. "We've had two hospitals file for bankruptcy this summer, and there are others with no margin or a negative margin." Medicaid already pays hospitals 71 cents and Medicare 92 cents for every $1 of care, and hospitals are being asked to take on huge expenses to implement electronic health record systems
The state has imposed rate payment reductions in FY 2009 and 2010 affecting inpatient and outpatient care, medical education funding, pay for performance funds, and reductions in extra pay for adult inpatient outlier cases.
The MHA said in its letter that it recognizes MassHealth has cost pressures from increased enrollment and utilization, "we believe that commonwealth must end its practice of balancing the MassHealth budget on the backs of hospitals.