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AHA Rejects Proposed Readmission Penalties

Cheryl Clark, for HealthLeaders Media, June 25, 2012

"There has been extensive research illustrating that readmission rates are statistically higher among dually eligible versus non-dually eligible and non-white versus white beneficiaries," Pollack's letter said.  "These factors are beyond the control of a hospital and must be adjusted for when calculating a hospital's readmission rate."

The letter includes two charts showing large differences in readmission rates between hospitals that serve more dually-eligible patients compared with non-dually eligibles, and between hospitals stratified by white versus non-white beneficiaries for each of three disease categories covered under the readmission penalty: heart attack, pneumonia and heart failure.

For example, hospitals serving non-dually eligible beneficiaries have readmission rates at 18.7%, 17.3%, and 23.7%. But hospitals serving dually eligibles have readmission rates that are much higher, at 24.3%, 20.1% and 27.4% respectively. 

By race, hospitals serving white beneficiaries have readmission rates at 19.3%, 17.7% and 24.1%, while hospitals serving non-white beneficiaries have readmission rates at 22.9%, 20.5% and 26.9% for those three disease categories.

Under the proposed rule, starting Oct. 1, payment adjustments to the hospital's base DRG take effect with the following breakdown:

  • 481 hospitals would receive the maximum 1% penalty
  • 76 hospitals will receive a .9% – .99% penalty
  • 77 hospitals will receive a .8% – .89% penalty
  • 110 hospitals will receive a .7% – .79% penalty
  • 118 hospitals will receive a .6% – .69% penalty
  • 129 hospitals will receive a .5% – .59% penalty
  • 180 hospitals will receive a .4% – .49% penalty
  • 196 hospitals will receive a .3% – .39 penalty
  • 228 hospitals will receive a 2% – .29 penalty
  • 280 hospitals will receive a .1% – .19% penalty
  • 347 hospitals will receive up to a .09% penalty and
  • 1,171 hospitals would receive no readmission penalty
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1 comments on "AHA Rejects Proposed Readmission Penalties"

Tom Johnson (6/25/2012 at 8:30 PM)
Rick Pollack is right on target with his criticisms of this CMS readmission penalty rule. Study after study have pointed out that patients in the lower socio-economic rung tend to have more co-mobidities; they tend to have less access to health care information; they often don't have access to primary care services; they don't have the same level of compliance to accepted health care guidelines for self care, etc. Their re-admission rate is bound to be higher and many of these patients are under Medicaid or are uninsured so hospitals taking care of a disproportionate share of these patients will be unfairly penalized. This CMS rule is a utopian rule not grounded in reality. Tom Johnson, LFACHE