76% of hospitals face readmissions penalties

Hospitals’ efforts to reduce readmissions within 30 days of discharge aren’t going very well, according to the latest numbers from the Centers for Medicare & Medicaid Services (CMS).  

Only 799 out of more than 3,400 hospitals—24 percent—subject to the Hospital Readmissions Reduction Program performed well enough on the CMS' 30-day readmission program to face no penalty. Meanwhile, 38 hospitals will be subject to the maximum 3 percent reduction.

The readmissions program, created under the Affordable Care Act, began with a 1 percent payment penalty in 2013 for readmissions for heart attack, heart failure and pneumonia. The penalty increased to 2 percent in 2014 and for fiscal year 2015 the penalty increased to 3 percent and chronic obstructive pulmonary disease and total hip and total knee replacements joined the list of conditions.

The final rule for Medicare's hospital inpatient prospective payment system that CMS issued last week includes several upcoming changes for the hospital inpatient quality reporting, excess readmissions, hospital-acquired condition and value-based purchasing programs. 

The readmission measure for pneumonia in fiscal 2017 expands the population cohort included in the analysis to patients with a principal discharge diagnosis of either sepsis or respiratory failure who also have a secondary diagnosis of pneumonia present on admission.