Must-Read: Ashish Jah: Readmissions Penalty at Year 3: How Are We Doing?
Must-Read: Readmissions Penalty at Year 3: How Are We Doing?: “A few months ago, the Centers for Medicare and Medicaid Services (CMS)…:
…put out its latest year of data on the Hospital Readmissions Reduction Program (HRRP)… the program within the Affordable Care Act (ACA) that penalizes hospitals for higher than expected readmission rates. We are now three years into the program and I thought a quick summary of where we are might be in order. I was initially quite unenthusiastic about the HRRP… but… have come to appreciate that as a utilization measure, it has value. Anecdotally, HRRP has gotten some hospitals to think more creatively…. A few years into the program, the evidence seems to be that the program is working – readmissions in the Medicare fee-for-service program are down about 1.1 percentage points nationally. To the extent that the drop comes from better care, we should be pleased….
In year 3, CMS expanded the conditions for which hospitals were being penalized to include COPD as well as surgical readmissions, specifically knee and hip replacements…. Here’s my take. Most hospitals got penalties in 2015 and a majority have been penalized all three years…. Safety-net hospitals are still getting bigger penalties, presumably because they care for more poor patients (who are more likely to come back to the hospital) but the gap has narrowed. This is good news. If we can move forward on actually adjusting the readmissions penalty for SES… and continue to make headway on improving risk-adjustment for medical readmissions, we can then evaluate and penalize hospitals on how well they care for their patients. And that would be a very good thing indeed.