Hospitals Still Lag in Meeting Medicare’s Bounceback Standards

Bouncebacks are patients who get readmitted to the hospital less than a month after they’ve been sent home. You want to keep the rate low, because too many bounceback admissions means the hospital is discharging patients too soon.

One element of the Affordable Care Act (ACA, or “Obamacare”) now in its fourth year is a review of hospital readmissions, and the imposition of penalties if facilities don’t meet the standards Medicare has established. As reported by (KHN), the latest review shows that most U.S. hospitals aren’t measuring up.

A readmission is when a former hospital inpatient must return for care within a month of his or her discharge. Readmissions are one way to measure hospital quality, and this year, 2,592 hospitals will receive less money from Medicare reimbursements as a penalty for a readmission rate that’s too high. The total loss: $420 million government dollars.

As KHN explained, “The Hospital Readmissions Reduction Program … was designed to make hospitals pay closer attention to what happens to their patients after they get discharged.”

Even hospitals that reduce their readmission rate lose money if they still don’t meet the threshold from one year to the next, so many claim that such rigid standards are unfair. According to KHN, all but 209 of the hospitals penalized this year also were penalized last year.

Although national readmission rates have dropped since the imposition of penalties, about 1 in 5 hospitalized Medicare patients still returns within a month.

Hospitals want Medicare and Congress to consider the demographics of their patients when determining readmission penalties, and they have a point claiming that that some factors for readmissions – such as whether patients can afford medications or healthful food – are beyond their control.

The commission that advises Congress on such matters has recommended altering the readmission penalties, and socio-economic factors are part of that discussion.

The fines are based on readmissions of Medicare patients originally hospitalized for one of these conditions: heart attack, heart failure, pneumonia, chronic lung problems or elective hip or knee replacements. Medicare determined an appropriate number of readmissions for each hospital, based on the mix of patients and how the hospital industry performed overall. If a certain facility’s number of readmissions was above that projection, it got fined.

The average penalty was a reimbursement reduction of .61% percent per patient stay; 38 hospitals will get the maximum cut of 3%. A total of 506 hospitals will lose 1% or more of their Medicare payments.

In general, the penalties are somewhat lighter than last year in terms of dollar amount and number of hospitals penalized. All states have hospitals subject to reduced payment except Maryland – it’s exempt from these penalties because it has a special payment arrangement with Medicare.

States with an unusually large number of penalized hospitals are Alabama, Connecticut, Florida, Massachusetts, New Jersey, New York, Rhode Island, South Carolina, Virginia, as well as the District of Columbia. States with lower numbers are Idaho, Iowa, Kansas, Montana, Nebraska, North Dakota and South Dakota.

But some hospitals with otherwise unacceptable readmission rates escape fines because they are exempted from evaluation either because they specialized in certain types of patients (veterans, children), because they were specially designated “critical access” hospitals or because they didn’t have enough Medicare patients to render accurate assessments.

You can see how your state stacks up in Medicare readmission penalties by linking to the KHN story. Also, see Patrick’s newsletters about how to maximize your chances of not being readmitted after discharge from a hospital, and how to choose a good hospital.

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