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Medicare 30-Day Readmission Rule Takes Effect With New Fiscal Year

On March 23, 2010, when President Obama signed into law comprehensive healthcare reform legislation, the Patient Protection and Affordable Care Act (ACA), it included a provision to reduce Medicare payments to certain hospitals with relatively high preventable readmissions rates.

Under Medicare's Inpatient Prospective Payment System (IPPS), as included in the (ACA), there will be adjustments to payments made for excessive readmissions in acute care hospitals. The government estimates about 2,200 hospitals will meet with penalties averaging $125,000 this coming fiscal year, which began Oct. 1.

Appropriate exclusions for readmissions unrelated to the prior discharge, such as planned admissions or hospital transfers, are included in the law. The law also targets certain areas of excessive hospital readmission as identified by Medicare and developed in conjunction with the National Quality Forum. The names of facilities fined under the law are to appear on the U.S. Dept. of Health & Human Services Hospital Compare website.

In 2005, the Medicare Payment Advisory Commission (MedPAC) reported that 17.6% of hospital admissions resulted in readmissions within 30 days of discharge; 11.3% within 15 days; and 6.2% within seven days, according to the Center for Medicare Advocacy.

In 2007, MedPac  identified seven conditions and procedures that accounted for almost 30% of potentially preventable readmissions, including  heart failure;

  • chronic obstructive pulmonary disease;
  • pneumonia;
  • acute myocardial infarction;
  • coronary artery bypass graft surgery;
  • percutaneous transluminal coronary angioplasty; and
    other vascular procedures.

Based on the work of MedPac, the ACA focuses initially on three conditions: heart attack, heart failure and pneumonia. In 2015, the policy expands to include COPD, CABG, PTCA and other vascular conditions, as identified by MedPAC in its June 2007 report.

According to the Congressional Research Service (CRS), reductions in hospital readmissions were identified by Congress and President Obama as a source for reducing Medicare spending in 2010. In addition, according to the CRS report, "Medicare Hospital Readmissions: Issues, Policy Options and PPACA," variations in readmission rates by hospital and region suggested some hospitals were better than others at containing readmission rates.

While no one path exists for all facilities to readmissions, some researchers and other experts asserted in the CRS report that relatively high readmission rates may be due to a number of factors, including:

  • inadequate relay of information at discharge to patients, caregivers, and post-acute care providers;
  • poor patient compliance with care instructions;
  • inadequate follow-up care from post-acute and long-term care providers;  
  • variation in hospital bed supply;
  • insufficient reliance on family caregivers;  
  • the deterioration of a patient's clinical condition; and
  • medical errors.

Click here to read more about hospitals, facilities and healthcare networks that have adopted protocols for reducing hospital readmissions in advance of health reform.


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  Last Post: February 4, 2013 | View Comments(3)

Nice article!!Thanks for updating this kind of content as it is more useful!!

julie February 04, 2013

As it carries benefit every one is following this scenario!!

julie February 01, 2013

I am a disabled nurse who has watched what has happened with medicare regulations and it's effect on healthcare for years. Since I am not working any longer I feel free to state bluntly what happens in reality with hospitals and some of these regulatios.
Medicare began paying a set amount for diagnosis several years ago. If a 95 year old fragile patient with multiple complicating health problems was admitted for a surgical procedure the reimbursment was the same as for a healthy 65 year old with no complicating factors. The fact is that illness and disease do not occur in a vacuum. All of the patient's diagnosis and health conditions will interact with one another. A 95 year old may get into trouble from IV fluids because their heart and kidneys are older and don't tolerate the same things a younger person has. Someone with multiple medical problems are many times more likely to have complications. In order to maintain a profit the hosptils began sending these patients home anyway even though they weren't stable in order to not lose money with the philosphy that if they did get into trouble they could come back and they would be paid again for another admission. Some patient's, of course, did not make it back. This was a poor way to be reimbursed even though the argument was that it forced the hospitals not to keep patients longer than needed.
With the new health care reform they have just removed even that safety net for patients. If a patient with severe COPD gets pneumonia the hospitals are still under pressure to discharge them in a few days and now emergency room doctors will be discouraged from readmitting them in that 30 day period even though in many such cases this would commonly be needed.
Follow up after discharge will NOT prevent all of this even though it it should be done. Suppose you are a home health nurse and see that the patient was discharged but they are running a temperature again and demonstrating low oxygen levels and they have severe COPD and heart failure and anemia. They need to go back in where they can be monitored closely! Such a patient could deteriorate very rapidly. This is the basic problem with politician's and bureucrats mandating health care! They don't know anything about medicine!Let the physicians who have gone to school for years for this reason use the knowledge they have.
I do not think that educating patients about their options in an end of life scenario is a "death panel" but this surely is! It is a way to decrease spending by unoficially denying those who have serious illnesses the care they need! You can cover it up with political gobblydygook phrasing but it is what it is. They should have not been allowed to take monies already desperately needed for a program for the nations most vulnerable citizens and redirect it to another program. Any new programs should have been passed with the understanding that they would be funded by a separate health care tax.

Beth Wootton,  RN,  currently disabledNovember 25, 2012
Ellettsville, IN


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