CMS Plans Readmissions Experiment But Expects Low Participation

CMS hopes to pilot a new, hybrid, hospital-wide readmissions measure that would estimate unplanned readmissions by leveraging Medicare claims data and clinical data from within the electronic medical record, according to the fiscal year 2018 IPPS final rule, Modern Healthcare, reported. CMS currently uses only its own claims data to evaluate unplanned readmissions. As it stands, hospitals face millions of dollars in readmission penalties next year and are still required to submit data for multiple quality measures.

The pilot is a precursor for a mandatory change (effective 2021) in hospital readmission penalties but CMS expects few volunteers to help in the pilot program, according to Modern Healthcare. Though the mandatory stage will incur penalties for readmissions, hospitals participating in the pilot program will not be penalized during the voluntary phase.

One potential reason for the low participation in the readmission pilot program could very well be the required metrics, according to Modern Healthcare.

Despite the roadblocks, CMS will need to find ways to entice hospitals to use the new voluntary measures. Without higher participation, the pilot program’s data may not accurately represent the 3,000 hospitals and therefore lead to a flawed quality measure.

Editor’s note: To read more about the 2018 IPPS final rule, click here. To read the 2018 IPPS Fact Sheet, including information on the readmissions programs, click here.