Medical Coding And Billing Online

Medicare & Medicaid Services

An analysis conducted on publicly available hospital data revealed that the financial penalties for US hospitals in the year 2014 would have been considerably changed, if the Centers for Medicare and Medicaid Services had equally weighted mortality and 30-day readmissions. Researchers also pointed out that the financial penalties for readmissions under CMS are approximately 10 times greater than that for the mortality.

The results of the analysis were published in a JAMA Cardiology report last week by lead researcher, Ahmad A. Abdul-Aziz, from the University of Michigan Health System and colleagues. “Under most circumstances, hospitalized patients would much rather avoid death than readmission. In the coming years, hospital financial penalties for readmissions will continue to overshadow those for mortality. If the goal of federal regulation is to align incentives and fairly reimburse hospitals for patient-centered outcomes, current CMS policy does not reflect these aims,” the researchers wrote.

According to the analysts, the Hospital Readmissions Reduction Program implemented by the CMS back in the year 2013 had penalized many hospitals for excess risk-standardized 30-day readmissions of Medicare patients, who suffered from acute MI, heart failure, and pneumonia. Furthermore, hospitals were also penalized for higher than expected risk-standard 30-day mortality for the above three diagnosis under the Hospital Value-Based Purchasing Program in the year 2014. However, the patients, who died within 30 days without hospitalizing, were excluded in the readmission penalties.

The research acquired the hospital-level data of approximately 1,963 hospitals during the financial year 2014 from the Kaiser Health News and Medicare website. They had details on readmission penalties, excess readmission ratio, and 30-day risk-standardized mortality rates for the above-mentioned three diagnoses. Researchers identified that even though the readmission penalties were able to closely track excessive readmissions, they had an inverse or minimal association with excess mortality and were modestly correlated with mortality and excess combined readmission.

Medical Billing Outsourcing Companies

Penalties For Readmissions

The study also revealed that almost 17 percent of hospitals had an excess readmission ratio of above 1 and they were all penalized, even though the same hospitals had an excess readmission ratio, which was below 1. In the meantime, hospitals with an excess readmission ratio of below 1 were not liable for penalties despite the fact that they had an excess combined outcome ratio of above 1.

The researchers concluded that approximately 50% of the hospitals in the US would not have been liable for penalties, if the CMS’s penalties for death were at least five times more significant than readmission. The Centers for Medicare and Medicaid Services is yet to comment on the report.

Leave a Comment

Your email address will not be published. Required fields are marked *