However, the AHA said that while it appreciated CMS' efforts to clarify "when an inpatient admission is appropriate—such as for a patient on observation status—we are concerned that this could be applied in a way that undermines medical judgment. We are also disappointed that CMS has proposed payment reductions in applying this policy. Hospitals always strive to provide the right care at the right time in the right setting.
Premier Healthcare Alliance's president Blair Childs said in a statement that Premier is pleased that CMS is broadening the number of conditions that would be exempt from the readmissions penalty "since these readmissions are not the result of gaps in care or poor quality," and will "result in a more accurate payment calculation.
However, he added, Premier is disappointed that CMS failed to introduce a socioeconomic risk adjustment in the readmissions algorithm. Research shows that socioeconomic factors "are more closely linked to high readmissions than poor quality of care, hospitals that serve high percentages of lower income patients will be disproportionately penalized for circumstances beyond their control."
Childs added that CMS inclusion of rates of central line-associated blood stream infections, catheter-associated urinary tract infections and AHRQ patient safety indicators "in both the value-based purchasing and the hospital acquired condition reduction programs, with additional overlaps in measured conditions proposed for the future," the proposed rule amounts to a "triple dip" into hospital payments, a three-time penalty for the same infection.
CMS has posted a searchable fact sheet for further information about the proposed rule.