26 Mar Forbes: Wisconsin Hospital Association Partners for Patients program improves quality, lowers health care costs
When you come home from a hospital stay, the last thing you want to see is the inside of that hospital again. But one in six discharged patients in the U.S. are back in their johnnies in less than 30 days, a third of them in less than seven days, at a national cost of more than $41 billion annually. That’s a hefty burden on patients, taxpayers and employers who pay those bills, and awful for patients.
To address the issue, a payment program by CMS, the agency that runs Medicare, ties three percent of total Medicare reimbursement to hospitals’ readmission rates. The program, called the Hospital Readmission Reduction Program (HRRP), is a little-known part of the Affordable Care Act that saved Medicare more than $2 billion last year according to the Medicare Payment Advisory Commission, a nonpartisan panel that advises Congress. The impact extends beyond Medicare beneficiaries because the incentive is based on readmissions for all patients.
But increasingly, critics are expressing concerns about flaws and unintended consequences.
One unintended consequence was observed in a study in the Journal of the American Medical Association (JAMA) this year, which found that, between 2005 and 2015, implementation of the readmissions reduction incentive coincided with a small but statistically significant increase in deaths within 30 days of discharge among patients hospitalized for heart failure or pneumonia. Meanwhile, researchers and federal officials found coding problems that may have resulted in exaggeration of the impact of the HRRP, and/or caused hospitals to “game” the billing system with no benefit to patients.
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