By Dana Kennedy, Health Policy Intern
Over 2200 hospitals nationwide are being penalized by the Medicare program because of their excessive readmission rates of Medicare patients. This is the result of a new program created under the Affordable Care Act, the Hospital Readmissions Reduction Program. According to Medicare this is two out of every three hospitals in the country.
Under this program hospitals can be penalized with a cut to Medicare reimbursements by one percent if excessive numbers of their patients are readmitted within 30 days of discharge. This penalty will go up to a maximum of three percent in 2014. The intent of the program is to give hospitals an incentive to provide quality patient care-the first time they serve them – resulting in fewer seniors ending up back in the hospital after the first health event.
This round of penalties for hospitals under the program totals $280 million. According to a report released by Kaiser Health News, 20 of Colorado’s 46 hospitals who serve Medicare patients will receive some cut in Medicare reimbursements for their readmission rates of Medicare patients. Only one Colorado hospital will receive the maximum penalty.
Despite the enthusiasm around the program’s potential to improve quality of care and reduce health, not everyone is pleased with the findings. According to a Kaiser Health News analysis penalties are more likely in hospitals that serve low-income populations than those with higher-income patients. This may be because impoverished patients, despite insurance status, may not have the resources for medications or transportation to follow-up appointments or regular access to primary care providers. These safety-net hospitals argue a cut in Medicare reimbursement puts an even greater strain on them when they are already struggling to meet their communities’ needs.
However, Denver’s largest safety net hospital, Denver Health, has been singled out as a hospital that serves a high percentage of low-income patients and does not have excessive readmissions. But Denver Health admits copying their system and that a penalty for readmissions may not be the best strategy to reducing hospital readmissions in a recent Kaiser Health News article. Denver Health cited its eight community health clinics and their lower cost services as one reason for its low readmission rates. Also a Denver Health representative pointed to the hospitals’ “busting at the seams” with patients as a high motivator to prevent readmissions. And while preventing readmissions is a goal, it is not fully attainable according to Denver Health. They say only about a quarter of readmissions are preventable.
The goal of having hospitals provide patients good care the first time they go to the hospital, so that they do not have to go back, can help in decreasing costs as well improving patient health. However, as this program has been implemented it has become obvious the challenge of reducing hospital readmissions is not cut and dry, or easy to respond to – especially for hospitals serving people with lower incomes and high health needs. However, programs like the Hospital Readmissions Reduction Program are a start at changing our health care delivery systems to becoming more centered around patients and their health outcomes.