What is the maximum penalty that a hospital can incur based on their readmission rates?
Medicare Readmission Penalties CMS caps penalties at 3% of a hospital’s reimbursement for its Medicare patient admissions. According to Kaiser, in FY 2017, the average hospital adjustment (among all hospitals) was -0.58%.
At what level of readmission rates are hospitals penalized?
The Affordable Care Act (ACA) established the Hospital Readmission Reduction Program (HRRP) in 2012. Under this program, hospitals are financially penalized if they have higher than expected risk-standardized 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia.
What counts as a 30 day readmission?
The HRRP 30-day risk standardized unplanned readmission measures include: Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. Patients who are readmitted to the same hospital, or another applicable acute care hospital for any reason.
Does Medicare pay for readmission within 30 days?
Medicare counts the readmission of patients who returned to a hospital within 30 days even if that hospital is not the one that originally treated them. In those cases, the penalty is applied to the first hospital.
What is the benchmark for readmission rate?
Benchmark readmission rates, based on the overall rate of readmission within 30 days of discharge for beneficiaries in each of 18 clinical risk groups over the 5-year period, ranged from 5.3% to 41.8% (Table 1).
How does CMS define a hospital readmission?
How is CMS readmission calculated?
The Observed Readmission Rate is the percentage of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days. It is equal to the Count of 30-Day Readmissions (Column 2) divided by the Count of Index Hospital Stays (Column 1).
What are Medicare fines?
Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($33.37 in 2022) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $. 10 and added to your monthly Part D premium.
What is the IPPs final rule for readmissions?
In the FY 2012 IPPS final rule, CMS finalized the following policies: Defined readmission as an admission to a subsection (d) hospital within 30 days of a discharge from the same or another subsection (d) hospital; Adopted readmission measures for the applicable conditions of acute myocardial infarction (AMI), heart failure (HF), and pneumonia
What is the hospital readmissions reduction program?
The Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions.
What are the 30-day risk-standardized unplanned readmission measures included in the program?
CMS includes the following six condition or procedure-specific 30-day risk-standardized unplanned readmission measures in the program: CMS calculates the payment reduction and component results for each hospital based on its performance during a rolling three-year performance period.
What are the changes to the pneumonia readmission measure?
Refined the pneumonia readmission measure by expanding the measure cohort to include additional pneumonia diagnoses: (1) patients with aspiration pneumonia and (2) sepsis patients coded with pneumonia present on admission, excluding severe sepsis, beginning with the FY 2017 program