AHA Rejects Proposed Readmission Penalties

Cheryl Clark, for HealthLeaders Media , June 25, 2012

Another AHA concern targets a 1.9% negative payment adjustment to account for case-mix coding between 2007 to 2009, which CMS indicates made it look like certain patients were more expensive to care for than they actually were.  And a third issue deals with potential loss of "Sole Community Hospital" favorable payment classification, given to facilities with fewer than 50 acute care beds that are rural or at least 35 miles away from a similar hospital.

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On the proposed rule's language on readmissions, Pollack's letter said, the AHA has "continually urged CMS to make changes to these readmission measures" to:


  • Properly adjust for patient characteristics (dual-eligible status and race/ethnicity);
  • Differentiate between planned and unplanned readmissions;
  • Differentiate between related and unrelated readmissions; and
  • Exclude extreme circumstances (transplant, end-stage renal disease, burn, trauma, psychosis and substance abuse.)

"The AHA strongly disagrees with CMS's decision and believes that the agency has ignored Congress's intent that the measures be modified to address thee factors," Pollack wrote.

Section 3025 of the Patient Protection and Affordable Care Act specifically calls for negative payment adjustments for higher rates of readmissions take into consideration "exclusions for readmissions that are unrelated to the prior discharge (such as a planned readmission or transfer to another applicable hospital)."

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1 comments on "AHA Rejects Proposed Readmission Penalties"

Tom Johnson (6/25/2012 at 8:30 PM)
Rick Pollack is right on target with his criticisms of this CMS readmission penalty rule. Study after study have pointed out that patients in the lower socio-economic rung tend to have more co-mobidities; they tend to have less access to health care information; they often don't have access to primary care services; they don't have the same level of compliance to accepted health care guidelines for self care, etc. Their re-admission rate is bound to be higher and many of these patients are under Medicaid or are uninsured so hospitals taking care of a disproportionate share of these patients will be unfairly penalized. This CMS rule is a utopian rule not grounded in reality. Tom Johnson, LFACHE




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