Newest round of readmission penalties raises concerns

March 18th, 2015

The latest round of Medicare readmission penalty numbers is in: Fines will be doled out to 2,610 hospitals, up from 2,225 last year, and 39 hospitals will receive the maximum 3% penalty, says Kaiser Health News.

Many states are seeing the majority of their hospitals penalized, including Florida (79%), Connecticut (88%), New York (80%), and New Jersey (98%).

Even though Medicare 30-day readmission rates have been dropping, the number of penalized hospitals is increasing. This time around, penalty criteria included patients admitted for elective hip and knee replacements, and those with chronic lung conditions – meaning more hospitals are subject to the penalties.

There has been much concern about the Medicare penalties and how they are computed, and no doubt the new numbers will only intensify the debate. Hospitals that improve their readmission rates can still be penalized if rates are not reduced enough. Safety-net hospitals are more prone to penalties due to difficulties with patients obtaining medications or follow-up care after discharge. The Hospital Readmission Accuracy and Accountability Act before Congress right now is aimed at risk-adjusting Medicare penalties for socioeconomic status. And this Journal of the American Medical Association editorial from March posits that 30-day readmissions could be a symptoms of larger problems – such as transition of care errors or pressure to free up beds – rather than problems in and of themselves. The authors also caution that all the focus on preventing readmissions could cause other patient health goals to fall by the wayside.

There is no question of whether readmission rates have been dropping. But there still doesn’t seem to be much hard data to show that these penalties are the main driving forces behind the improvements.