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HomeHealthHealth careOne in four hospitals won't be charged readmissions penalties

One in four hospitals won’t be charged readmissions penalties

CMS can also be suppressing the pneumonia readmissions measure from its assessment and eliminating diagnosis-related group cost coverage and extra readmission ratio calculations for hospitals with extraordinary circumstance exceptions.

Because hospitals should have a minimal variety of instances to be scored on varied readmissions measures, excluding six months of claims may imply some hospitals don’t meet the information threshold, Demehin mentioned. 

“When hospitals can’t get scored on certain measures, it could cause their penalty to go down,” he mentioned.

In fiscal 12 months 2022, 17.81% of hospitals had no readmissions penalty. For the upcoming 12 months, 25.33% of hospitals is not going to be penalized on their readmissions, and there might be a 57% lower within the variety of hospitals paying penalties exceeding 1%. 

The common penalty for hospitals with the very best proportion of Medicare-Medicaid dual-eligible sufferers—peer group 5—is 0.23%. For hospitals with the bottom variety of duals-eligible sufferers—peer group one—the typical penalty is 0.37%. During fiscal 12 months 2022, teams 5 and one have been penalized 0.60% and 0.42%, respectively, on their readmissions.

This 12 months’s greater charge of penalty-free hospitals is just not unprecedented, although the business hasn’t seen related charges since fiscal years 2014 and 2015, Demehin mentioned. Penalties have been on the rise since CMS started including extra measures to the readmissions program.

Although the decrease proportion of penalties might be due partially to hospitals’ progress with decreasing readmissions, Demehin mentioned well being methods have been considerably improving on measures earlier than the pandemic and nonetheless noticed penalty charges enhance. 

“It doesn’t necessarily feel like progress is being rewarded,” he mentioned. “While the number of hospitals getting a penalty for this fiscal year is smaller than it was in prior years, it’s important to note that around three quarters of hospitals are still getting readmissions penalties.”

Aside from stakeholders’ uncertainty concerning the cost penalty components and its potential to encourage enchancment, it is evident that many hospitals have been centered all through the pandemic on managing readmissions and sustaining their high quality metrics, mentioned Rick Kes, senior healthcare analyst at RSM. 

“I think we might continue seeing improvements in these areas, despite the headwinds of labor and expenses going up much faster than hospitals’ revenue,” he mentioned.

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