News: Half of the nation’s hospitals fined for readmission rates, analysis finds

Almost half of hospitals in the United States will be getting lower payments for Medicare patients due to their readmission history, according to an analysis reported in Kaiser Health News. These latest penalties are part of the Hospital Readmissions Reduction Program (HRRP) and were calculated using hospital case history between July 2016 and June 2019 so that COVID-19 patients would not skew the data.

The analysis states that for this year, “Medicare will lower a year’s worth of payments to 2,545 hospitals,” and that “the average reduction is 0.69%, with 613 hospitals receiving a penalty of 1% or more.”

From the 5,267 hospitals in the United States, Congress has exempted 2,176 from penalties either because they are critical access hospitals or hospitals specialized in psychiatric patients, children, veterans, rehabilitation, or long-term care. Of the remaining 3,080 hospitals evaluated, 2,545 received a penalty.

Penalties are based on readmissions of Medicare patients who were initially admitted with congestive heart failure, heart attack, pneumonia, chronic obstructive pulmonary disease, hip or knee replacement, or coronary artery bypass graft surgery and were then readmitted within 30 days of discharge (with the exception of planned returns). Hospitals are penalized if their readmission rates are higher than expected using national trends on the giving diagnosis category.

Editor’s note: The Kaiser Health News analysis report can be found here. To read about a recent study published in the Journal of the American Medica Association about HRRP inaccuracies, click here.