Medicare hospital readmissions reduction program Archives - Page 3 of 4

Congress to Consider Adding Risk Adjustment to Medicare Readmissions Program

A new bill introduced in Congress last week would require Medicare to consider the socio-economic status of the patients individual hospitals serve as part of its hospital readmissions reduction program.
The Establishing Beneficiary Equity in the Hospital Readmissions Program Act of 2015 was introduced as S. 688 in the Senate, sponsored by Senators Rob Portman (R-OH) and Joe Manchin (D-WV), and in the House by Representatives Jim Renacci (R-OH) and Eliot Engel (D-NY) as H.R. 1343.
Rep. Renacci introduced a similar measure last year. This year’s version has bipartisan sponsorship in both the House and Senate.
Since the launch of Medicare’s readmissions reduction program several years ago, a number of studies have suggested that the program is unfair to hospitals that serve especially large numbers of low-income patients. The new proposal seeks to address that unfairness.
Pennsylvania’s safety-net hospitals serve especially large numbers of low-income patients and have been especially vulnerable to the readmissions reduction program’s penalties.
To learn more about this proposal, see this news release announcing the bill. Find the bill itself here.

PA Safety Net Admin2015-03-16T06:00:53+00:00March 16th, 2015|Uncategorized|Comments Off

Residents of Disadvantaged Neighborhoods More Likely to Require Readmission

Medicare beneficiaries living in the most disadvantaged neighborhoods are more likely than others to require readmission to the hospital for problems associated with congestive heart failure, pneumonia, or myocardial infarction.
This is one of the findings in a new Annals of Internal Medicine study titled “Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization: A Retrospective Cohort Study.”
The study, based on data from 2004 through 2009, compared Medicare readmission rates in different geographic areas using what is called a validated area deprivation index that measures relative socioeconomic disadvantage to identify the most disadvantaged areas. Researchers concluded that

The 30-day rehospitalization rate did not vary significantly across the least disadvantaged 85% of neighborhoods, which had an average rehospitalization rate of 21%. However, within the most disadvantaged 15% of neighborhoods, rehospitalization rates increased from 22% to 27% with worsening ADI.

These findings document the special challenges Pennsylvania’s private safety-net hospitals face in serving some of the most disadvantaged communities in the state.
Find the study here, on the web site of the Annals of Internal Medicine.

PA Safety Net Admin2014-12-12T06:00:34+00:00December 12th, 2014|Uncategorized|Comments Off

Congressman Calls for Helping Safety-Net Hospitals by Improving Medicare Readmissions Program

Congressman James Renacci (R-OH) is again asking his House colleagues to support his proposal to adjust Medicare’s hospital readmissions reduction program – a program he maintains is especially harmful to safety-net hospitals.
Noting that in its current form the program penalizes hospitals that care for larger numbers of poorer, sicker patients and that this “jeopardizes the viability of hospitals that service this vulnerable population,” the congressman urges his colleagues to support his bill, H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmissions Program Act.
This bill calls for adjusting the program’s approach “to account for certain disparities in patient population…”
See Representative Renacci’s letter to House colleagues here.

PA Safety Net Admin2014-10-22T11:44:02+00:00October 22nd, 2014|Uncategorized|Comments Off

Medicare Announces Readmissions Penalties

Medicare will impose financial penalties in FY 2015 on the majority of U.S. hospitals for excessive patient readmissions.
In all, 2610 hospitals face penalties that range from one one-hundredth of one percent to three percent of all Medicare payments. Last year, the maximum penalty was two percent.
The majority of hospitals in 29 states will be penalized and 39 hospitals face the maximum penalty of three percent. Overall, the penalties will amount to $428 million. Many hospitals will be penalized even though they reduced their readmissions in the past year.
Medicare’s hospital readmissions reduction program was mandated by the Affordable Care Act in the belief that penalizing hospitals for what were considered avoidable readmissions would spur them to take steps to prevent such readmissions. Readmissions cost Medicare $26 billion a year, of which $17 billion is considered unavoidable.
Concerns have been raised that the readmissions penalties are unfair to safety-net hospitals because they serve more low-income patients with more complex medical problems and who, after discharge, face financial and logistical challenges during their recovery that make them more likely to require readmission. Some studies have verified this view and some groups – including the Medicare Payment Advisory Commission (MedPAC) – have called on Congress to revise the program with this consideration in mind.
For a closer look at FY 2015’s readmissions penalties, including links to a file that lists individual hospital penalties nation-wide, see this Kaiser Health News report.

PA Safety Net Admin2014-10-06T06:00:33+00:00October 6th, 2014|Affordable Care Act|Comments Off

Readmissions and Quality: Are They Related?

A new study casts doubt on a major principle underlying a good deal of recent federal health care policy.
That principle holds that hospitals that have lower rates of 30-day readmissions of Medicare patients provide better, more economical care than those with higher readmission rates.
But that may not be true.
According to an examination of the performance of safety-net hospitals in California published in the journal Health Affairs, those safety-net hospitals are more likely than others to be penalized by Medicare’s hospital readmissions reduction and value-based purchasing programs.
At the same time, however, these same hospitals had lower 30-day, risk-adjusted mortality rates for patients treated for myocardial infarction, heart failure, and pneumonia. The safety-net hospitals also had marginally lower adjusted Medicare costs.
Find out more about the findings of the study “California Safety-Net Hospitals Likely to be Penalized by ACA Value, Readmission, and Meaningful-Use Programs,” which can be found here, on the web site of the journal Health Affairs.

PA Safety Net Admin2014-08-21T06:00:31+00:00August 21st, 2014|Affordable Care Act, Health care reform|Comments Off

Group to Assess Impact of Socioeconomic Factors on Care

The National Quality Forum (NQF) will perform a “robust trial” to assess the role and impact of sociodemographic factors on health care outcomes.
In a news release, the NQF announced that

Sociodemographic factors can be socioeconomic, e.g., income, education, and occupation, and demographic, e.g., race, ethnicity, and primary language. Growing evidence shows that sociodemographic factors may influence patient outcomes, which has implications for comparative performance measurement used in pay-for-performance programs.

Among the socioeconomic and sociodemographic factors the NQF will consider are income, education, and occupation, and demographic considerations such as race, ethnicity, and primary language.
With the Affordable Care Act requiring Medicare to adjust payments based on outcomes such as hospital readmissions, value-based purchasing requirements, hospital-acquired conditions, and more, reviews of the preliminary results of such programs have led some to question whether hospitals that serve especially large numbers of low-income patients – like Pennsylvania’s safety-net hospitals – may be especially and unfairly harmed by such programs.
Learn more about the NQF plan for a new study from this news release and find a link to further information about the planned study as well.

PA Safety Net Admin2014-07-25T06:00:35+00:00July 25th, 2014|Affordable Care Act|Comments Off

Stop Hurting Hospitals That Serve the Poor, HHS Told

Medicare’s hospital readmissions reduction program is unfairly penalizing hospitals that serve especially large numbers of low-income patients, 34 members of Congress have written in a letter to recently appointed Health and Human Services Secretary Sylvia Mathews Burwell and Centers for Medicare & Medicaid Services (CMS) administrator Marilyn Tavenner.
The letter, sponsored by Rep. James Renacci (R-Ohio), notes that while the program has

…incentivized hospitals to reduce readmissions, there are some factors outside of a hospital’s control that make it difficult for the patient to avoid readmission. The current penalty methodology…has created an unintended consequence for hospitals that service our most vulnerable populations – dual-eligible beneficiaries; low-income seniors, or people with disabilities that are eligible for both Medicare and Medicaid.

The letter also notes financial penalties imposed by the program “jeopardizes the viability of hospitals that service our nation’s most vulnerable population” and that H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmissions Program,

…adjusts the penalty methodology for hospitals servicing larger amounts of dual-eligible beneficiaries and excludes patients with certain extenuating circumstances from the penalty calculations. Adjusting the penalty to account for certain disparities in patient population can make a big difference to hospitals across the country and the nine million dually-eligible beneficiaries that rely on these hospitals for their critical care needs.

Pennsylvania’s safety-net hospitals are among those hurt by the program in its current form.
Read the House letter to Secretary Burwell and Administrator Tavenner here.

PA Safety Net Admin2014-06-19T06:00:16+00:00June 19th, 2014|Uncategorized|Comments Off

Report Questions Fairness of Medicare Quality and Incentive Programs

A draft technical report by the National Quality Forum has called into question the fairness of Affordable Care Act Medicare programs that seek to provide financial incentives to hospitals that meet selected quality care standards and penalize those that fail to meet those standards.
According to the report, which was commissioned by the Obama administration, these programs unfairly penalize hospitals that care for especially large numbers of low-income seniors – hospitals like those that belong to the Safety-Net Association of Pennsylvania.
The report notes, according to the New York Times, that

Low-income people may be unable to afford needed medications or transportation to doctor’s offices and clinics, the panel said. If they have low levels of formal education or literacy, they may have difficulty understanding or following written instructions for home care and the use of medications. In addition, the clinics and hospitals they use may lack the resources and high tech equipment needed to diagnose and treat illnesses.

Among the programs cited for this problem are Medicare’s value-based purchasing program and its hospital readmissions reduction program.
Read more about the programs’ challenges, as well as the views of those who believe the programs are working as intended and should not be adjusted, in this New York Times article. Go here, to the National Quality Forum’s web site, for a direct link to the study, titled “Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors.”

PA Safety Net Admin2014-04-28T10:41:20+00:00April 28th, 2014|Affordable Care Act, Safety-Net Association of Pennsylvania|Comments Off

Bill in Congress Would Benefit PA Safety-Net Hospitals

New legislation introduced in Congress would add a risk adjustment component to Medicare’s hospital readmissions reduction program.
Such a measure would benefit Pennsylvania’s safety-net hospitals.
H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmission Program Act, proposes modifying Medicare’s hospital readmissions reduction program. Under the bill, hospitals’ performance in preventing Medicare readmissions would be risk-adjusted for patients who are dually eligible for Medicare and Medicaid; for patients who are considered non-compliant; for patients whose readmission has been classified as based on psychosis or substance abuse; and for patients who have specific medical conditions.
Hospitals found to have too many Medicare readmissions suffer financial penalties under Medicare’s hospital readmissions reduction program. Recent studies suggest that in its current form, the program unfairly targets safety-net hospitals for financial penalties.
Learn more about the bill from this news release from its sponsor, Rep. James Renacci (R-Ohio), or find the bill itself here.

PA Safety Net Admin2014-03-17T06:00:07+00:00March 17th, 2014|Uncategorized|Comments Off

Safety-Net Hospitals Hurt More by Readmissions Reduction Program

Hospitals that care for large numbers of low-income seniors are disproportionately harmed by Medicare’s hospital readmissions reduction program, according to a new study.
According to the study,

Both patient dual-eligible status and a hospital’s dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations.

Because they care for so many more low-income patients than the typical hospital, Pennsylvania’s safety-net hospitals are especially vulnerable to the Medicare hospital readmissions reduction program’s financial penalties.
The study, “The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations,” was published recently in Health Services Research and can be found here.

PA Safety Net Admin2014-01-22T06:00:20+00:00January 22nd, 2014|Affordable Care Act|Comments Off

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