Medicare Pay Cuts for Poor Readmission Scores Begin

Cheryl Clark, for HealthLeaders Media , October 1, 2012

Medicare's "dry-run" charts indicate that for 30-day readmissions penalties, 278 hospitals will be dinged the full 1% of their Medicare base DRG payment.  Another 522 hospitals will receive a penalty of about one-half of a percent and 1,413 hospitals will be penalized less than one-half of a percent.

And 1,188 hospitals will not be penalized because their readmission rates were lowest in the country.

A Likely Winner
One of those double-headliners is Lincoln Surgical Hospital in Lincoln, NE, which also may receive the highest value-based purchasing adjustment factor of all hospitals eligible for the program.  Under the dry-run estimates, for every $100 of Medicare base DRG that goes into the pool, Lincoln will get that entire $100 plus 91 cents.  Additionally, Lincoln will not receive a penalty for its 30-day readmissions.

Asked how Lincoln accomplished such good results, CEO Robb Linafelter says the trick is being focused, and being physician-owned. "When you look at the HCAHPS and the quality measures, those are two things we focus on. The first is our patients and families, and meeting their needs, and second is our physicians, and third is our employees."

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