Like most hospitals and health system administrators, the leadership at New Hanover Regional Medical Center, a 628-bed teaching hospital in Wilmington, NC, is concerned about the Centers for Medicare & Medicaid Services' reimbursement penalties for excessive 30-day readmissions.
CMS's Hospital Readmission Reductions Program began in October 2012 by penalizing hospitals up to 1% of their Medicare reimbursements for high readmission rates for patients with heart attack, heart failure, and pneumonia.
The stakes are increasing as the maximum financial penalty grows to 3% by fiscal year 2015, and chronic obstructive pulmonary disorder and total hip and knee replacements are added to the list of health conditions included in the calculation.
"We are one of only a couple of providers in North Carolina that hasn't been fined for readmission rates in the last two years, but we are still working hard and fast on not getting a readmissions penalty from CMS," says David Parks, the hospital's vice president cardiac and clinical support.
Reducing Risk of Payment Penalties
As part of its readmission reduction project, New Hanover launched a community paramedicine program in early 2014 in which paramedics work with patients dealing with complications from chronic illness with the goal of providing in-home care whenever possible.