As the Centers for Medicare & Medicaid Services continues to ramp up payment penalties for hospitals with high 30-day readmission rates, it's becoming more important than ever for hospitals and health systems to get a handle on this key quality measure.
Launched in October 2012, CMS's Hospital Readmission Reductions Program began by penalizing hospitals up to 1% of their Medicare reimbursements for excessive readmissions of patients with heart attack, heart failure, and pneumonia.
The financial consequences are gradually mounting, and by fiscal year 2015, CMS will expand the program to include a maximum penalty to 3%. Chronic obstructive pulmonary disorder and total hip and knee replacements will also be added to the list of medical conditions factored into the calculation.
Hospital leaders are well aware of the dollars that are now at risk. In the HealthLeaders Media September 2013 Readmissions Buzz Survey, 85% of respondents indicated that CMS's readmissions penalty is addressed in their organization's current business plan.
Improving Transitions to the Outpatient Setting
Roughly one in five Medicare patients is readmitted to a hospital less than a month after discharge. One strategy for reducing this number is to improve the transition from the hospital to the post-acute care setting, says Marc Berliant, MD, associate chair of medicine at the University of Rochester (NY) Medical Center.