Patient Readmission Rates: One Metric to Closely Monitor

August 22, 2013
Rachel V. Rose, JD, MBA
Rachel V. Rose, JD, MBA

Rachel V. Rose, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at Baylor College of Medicine in Houston. Rachel can be reached through her website, www.rvrose.com.

With more than 2,200 hospitals recently notified of reimbursement reductions by CMS, now is the time for physicians to watch those readmission rates.

On August 2, CMS released a rule, which identified 2,225 hospitals to receive $227 million in Medicare reimbursement reductions beginning October 1, 2013. This is part of the 2,225 pages of final rules, which address a variety of related programs*. These hospitals in particular were identified because of their outlier statistics relating to 30-day readmission rates for heart attack, heart failure, and pneumonia. The maximum penalty was also increased from 1 percent to 2 percent. It is also prudent to closely monitor readmission rates for total joints and chronic obstructive pulmonary disease now because they are slated to be included in FY 2015.

There were approximately 3,359 hospitals eligible for penalties, which equates to nearly two-thirds being fined. This was similar to the Year 1 statistics, which began in October 2012. Under the readmissions program, hospitals landing in the top third of relative performance are exempt from the fine. The primary purpose behind the initiative, like ICD-10 or accountable care organizations, is to improve the quality of care.

According to Amy Boutwell, MD, president of Collaborative Healthcare Strategies, "I was very pleased to see that the readmission rates are changing, because there’s been a lot of talk about how difficult it is for hospitals to impact the CMS measures." From Boutwell’s perspective, this equates to a belief that the collaborative approach taken by hospitals and their partner providers can result in improved measures.

The takeaway for physicians and hospitals underscores the importance of specific clinical documentation upon admission to the facility by the clinician and management of patients with comorbid conditions - such as diabetes - which can impact the recovery process.


*42 C.F.R. 412, 413, 414, 419, 424, 482, 485, and 489