How can we reduce the 30-day readmissions of patients with CHF?
We conducted a quality improvement project at our hospital with the objective to reduce the 30-day all-cause readmissions of patients with CHF by improving the transition of care and setting up scheduled follow-up appointments within two weeks of patient discharge.
Why are hospitals getting lower Medicare payments for readmitted patients?
Nearly half the nation’s hospitals, many of which are still wrestling with the financial fallout of the unexpected coronavirus, will get lower payments for all Medicare patients because of their history of readmitting patients, federal records show.
What is the hospitalization rate for congestive heart failure (CHF)?
DOI: 10.7759/cureus.7420 Abstract Background Congestive heart failure (CHF) is the most common cause of hospitalization in the US for people older than 65 years of age. It has the highest 30-day re-hospitalization rate among medical and surgical conditions, accounting for up to 26.9% of the total readmission rates.
What is a hospital readmission for Medicare?
According to Medicare, a hospital readmission is "an admission to an acute care hospital within 30 days of discharge from the same or another acute care hospital." However, a readmittance for follow-up care does not constitute a "readmission" for Medicare.
What was the readmission rate for congestive heart failure CHF )?
Congestive heart failure (CHF) is the most common cause of hospitalization in the US for people older than 65 years of age. It has the highest 30-day re-hospitalization rate among medical and surgical conditions, accounting for up to 26.9% of the total readmission rates.
What is the 30-day readmission rate for heart failure?
Nearly 1 in 4 heart failure (HF) patients are readmitted within 30 days of discharge and approximately half are readmitted within 6 months.
What percentage of patients are readmitted?
In 2018, there were a total of 3.8 million adult hospital readmissions within 30 days, with an average readmission rate of 14 percent and an average readmission cost of $15,200.
What percent of Medicare patients are readmitted within 30 days?
The MedPAC staff's preliminary analysis, made public last month, found that the frequency of Medicare patients being readmitted within 30 days of discharge dropped from 16.7% in 2010 to 15.7% in 2017.
How long is hospital stay for congestive heart failure?
Median length of stay was 4 [2–6] days: 10% stayed <2 days, and 70% had <6 days. Median charges were 19,978 [11,466-36,809] USD.
Why do heart failure patients get readmitted?
The biggest period of vulnerability for heart failure patients is the first 30 days after discharge, and lack of follow up by hospitals in that first 30 days can be a huge contributor to subsequent readmissions.
What is the Medicare 30-day readmission rule?
Medicare counts as a readmission any of those patients who ended up back in any hospital within 30 days of discharge, except for planned returns like a second phase of surgery. A hospital will be penalized if its readmission rate is higher than expected given the national trends in any one of those categories.
What is Medicare readmission rate?
Patients in Medicare Advantage had lower unadjusted readmission rates than those in traditional Medicare for all 3 conditions (16.6% vs. 17.1% for AMI, 21.4% vs. 21.7% for CHF, and 16.3% vs. 16.4% for pneumonia).
How many patients are readmitted?
Readmissions following hospital discharge are common and used by many individuals and organizations as a measure of the quality of care provided by physicians and hospitals. As reported by the Centers for Medicare Services,4 approximately 1 in 5 patients are readmitted to the hospital within 30 days of discharge.
How many Medicare beneficiaries are readmitted within 30 days every year?
The study found that 19.6% of beneficiaries were readmitted within 30 days of their initial discharge, 34% within 90 days and 56.1% within 12 months (Shelton, Chicago Tribune , 4/1).
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.
How do you calculate readmission rate?
Readmission rate: number of readmissions (numerator) divided by number of discharges (denominator); each readmission should be counted only once to avoid skewing the rate with multiple counts.
How long can you stay in a hospital with Medicare?
Medicare measures your use of inpatient hospital services in “benefit periods.” A benefit period begins the day you’re admitted as an inpatient in a hospital and ends when you haven’t had any inpatient hospital care for 60 days in a row. You can have more than one hospital stay within the same benefit period. There’s a limit on how many days Medicare covers during a benefit period, but there’s no limit on the number of benefit periods you can have over your lifetime. If you’re an
What format do you need to get Medicare information?
You have the right to get Medicare information in an accessible format, like large print, Braille, or audio. You also have the right to file a
How to appeal Medicare payment decision?
For more information on appeals, visit Medicare.gov/claims-appeals, or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. If you’re a hospital inpatient and think you’re being discharged too soon, you have the right to an immediate
Does Medicare cover hospital services?
Medicare helps cover certain medical services and supplies in hospitals. If you have both Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), you can get the full range of Medicare-covered services in a hospital.
How does the Hospital Readmissions Reduction Program adjust payments?
For each eligible hospital, we calculate the payment adjustment factor. The payment adjustment factor corresponds to the percent a hospital’s payment is reduced. The payment adjustment factor is a weighted average of a hospital's performance across the six HRRP measures during the HRRP performance period. We apply the payment adjustment factor for all discharges in the applicable fiscal year, no matter the condition.
How will I know whether CMS incorporated changes to the Hospital Readmissions Reduction Program?
These changes are published annually after a public comment period, with the Inpatient Prospective Payment System /Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS) Final Rule.
What are applicable Hospital Readmissions Reduction Program hospitals?
Section 1886 (d) (1) (B) of the Social Security Act defines applicable hospitals under HRRP.
What measures are included in the Hospital Readmissions Reduction Program?
We use the excess readmission ratio (ERR) to assess hospital performance. The ERR measures a hospital’s relative performance and is a ratio of the predicted-to-expected readmissions rates. We calculate an ERR for each condition or procedure included in the program:
What is the Review and Correction period?
The 30-day Review and Correction period allows applicable hospitals to review and correct their HRRP Payment Reduction and component result calculations as reflected in their HSR (i.e., Payment Adjustment Factor, Dual Proportion, Peer Group Assignment, Neutrality Modifier, ERR, and Peer Group Median ERRs) prior to them being used to adjust payments. Hospitals can’t submit corrections to the underlying claims data or add new claims to the data extract during this period.
What is HRRP in healthcare?
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 . Section 3025 of the Affordable Care Act required the Secretary of the Department of Health and Human Services ...
How does HRRP help?
HRRP improves Americans’ health care by linking payment to the quality of hospital care. CMS incentivizes hospitals to improve communication and care coordination efforts to better engage patients and caregivers on post-discharge planning.
Why are hospitals financially incentivized to discharge patients?
Since hospitals are paid by the DRG (in other words, by the diagnosis), hospitals are financially incentivized to discharge patients as quickly as possible in order to reduce their expenses. The Medicare hospital readmission reduction program was designed to offset that financial incentive by penalizing hospitals that discharge patients prematurely.
How does Medicare respond to the penalty based on a given hospital’s patient demographics?
Medicare responded by making 2 adjustments to the penalty based on a given hospital’s patient demographics: The severity of illness of the hospital’s patients (often called the case mix index) with the premise that the sicker a patient is, the more likely that patient is to be readmitted to the hospital. The rate of “dual eligible” patients, that ...
What is the unintended consequence of the Medicare readmissions reduction program?
In a previous post, I commented on the unintended consequence of the Medicare hospital readmissions reduction program, specifically that the program is associated with an increase in outpatient mortality. Since hospitals are paid by the DRG (in other words, by the diagnosis), hospitals are financially incentivized to discharge patients as quickly as possible in order to reduce their expenses. The Medicare hospital readmission reduction program was designed to offset that financial incentive by penalizing hospitals that discharge patients prematurely. Overall, the current readmission penalty program appears to be more fair to hospitals that care for socioeconomically disadvantaged patients. However, the danger remains that by creating a barrier for hospitals to readmit patients who truly need to be readmitted, outpatient mortality can increase.
What is the Medicare quintile?
Medicare divided all U.S. hospitals into quintiles based on the percentage of dual eligible patients. Hospitals were only compared to other hospitals within the same quintile for the purposes of penalty calculation; therefore, a hospital with a high percentage of dual eligible patients was held to a different readmission rate expectation ...
What is readmission reduction?
The hospital readmission reduction program was created as a part of the Affordable Care Act as a way to improve quality of care and reduce overall Medicare costs. Readmissions are defined as a patient being readmitted to any hospital and for any reason within 30 days of discharge from the hospital being analyzed.
What is the Medicare readmission penalty for 2020?
The 2020 Medicare Readmission Penalty Program. Each year, Medicare analyzes the readmission rate for every hospital in the United States and then imposes financial penalties on those hospitals determined to have excessively high readmission rates. And every year, most U.S. hospitals get penalized. This year is no exception – 83% ...
Is the readmission penalty fair?
Overall, the current readmission penalty program appears to be more fair to hospitals that care for socioeconomically disadvantaged patients. However, the danger remains that by creating a barrier for hospitals to readmit patients who truly need to be readmitted, outpatient mortality can increase. November 17, 2019.
How many Medicare patients are readmitted within one month of discharge?
When the program was implemented, about 20% of Medicare patients were readmitted to a hospital within one month of discharge; CMS considered this number excessive and believed that readmissions are an indicator of quality of care, or lack thereof. This new program provides an incentive for hospitals to decrease readmissions by coordinating transitions of care and increasing the quality of care provided to Medicare beneficiaries. The program is part of CMS’ goal to transition to value-based purchasing--paying for care based on quality and not just quantity.
What is the initial hospital inpatient admission for the applicable conditions?
The initial hospital inpatient admission for the applicable conditions (see FAQ2) (the discharge from which starts the 30-day potential penalty clock) is termed the “index” admission.
How many condition/procedure-specific 30-day risk-standardized unplanned readmission measures are there?
CMS includes the following six condition/procedure-specific 30-day risk-standardized unplanned readmission measures in the program:
What is excess readmission ratio?
The excess readmission ratio includes adjustments for clinical factors such as patient demographic attributes, comorbidities, and patient “frailty.”. Hospitals are compared with a national average readmission ratio that generally applies to a hospital’s patient population and the applicable condition.
What is readmission reduction?
It is meant to help ensure that hospitals discharge patients when they are fully prepared and safe for continued care at home or at a lower acuity setting. The Affordable Care Act of 2010 requires HHS (Department of Health and Human Services) to establish a readmission reduction program.
What is the Affordable Care Act?
Recommendations. Answer. The Affordable Care Act of 2010 requires HHS (Department of Health and Human Services) to establish a readmission reduction program. This program, effective October 1, 2012, was designed to provide incentives for hospitals to implement strategies to reduce the number of costly and unnecessary hospital readmissions.
What is the role of an ED in a hospital?
Commensurate with good patient care, the ED will likely have to work with hospital case managers and discharge planners to determine if there are safe alternative care settings other than a hospital inpatient status. ED physicians should be proactive with the hospitals and medical staffs to develop programs and processes to address these readmissions. Vigorous and timely support from case management and/or social services will be important.
What is the ninth round of the Hospital Readmissions Reduction Program?
The penalties are the ninth annual round of the Hospital Readmissions Reduction Program created as part of the Affordable Care Act’s broader effort to improve quality and lower costs.
How many hospitals are exempt from the threat of penalties?
Out of 5,267 hospitals in the country, Congress has exempted 2,176 from the threat of penalties, either because they are critical access hospitals — defined as the only inpatient facility in an area — or hospitals that specialize in psychiatric patients, children, veterans, rehabilitation or long-term care. Of the 3,080 hospitals CMS evaluated, 83% received a penalty.
Why are Medicare payments being lower?
Nearly half the nation’s hospitals, many of which are still wrestling with the financial fallout of the unexpected coronavirus, will get lower payments for all Medicare patients because of their history of readmitting patients, federal records show.
What happens if readmission rate is higher than expected?
A hospital will be penalized if its readmission rate is higher than expected given the national trends in any one of those categories.
Is Medicare suspending the penalty program?
The Centers for Medica re & Medicaid Services announced in September it may suspend the penalty program in the future if the chaos surrounding the pandemic, including the spring’s moratorium on elective surgeries, makes it too difficult to assess hospital performance.
Is Medicare a readmission?
The penalties are based on readmissions of Medicare patients who initially came to the hospital with diagnoses of congestive heart failure, heart attack, pneumonia, chronic obstructive pulmonary disease, hip or knee replacement or coronary artery bypass graft surgery. Medicare counts as a readmission any of those patients who ended up back in any hospital within 30 days of discharge, except for planned returns like a second phase of surgery.
How long does CMS give hospitals to review their HSRs?
CMS sends confidential Hospital-Specific Reports (HSRs) to hospitals annually. CMS gives hospitals 30 days to review their HRRP data as reflected in their HSRs, submit questions about the calculation of their results, and request calculation corrections. The Review and Correction period for HRRP is only for discrepancies related to the calculation of the payment reduction and component results.
How many condition or procedure specific unplanned readmission measures are there?
CMS includes the following six condition or procedure-specific 30-day risk-standardized unplanned readmission measures in the program:
What is CMS payment reduction?
The payment adjustment factor is the form of the payment reduction CMS uses to reduce hospital payments. Payment reductions are applied to all Medicare fee-for-service base operating diagnosis-related group payments during the FY (October 1 to September 30). The payment reduction is capped at 3 percent (that is, a payment adjustment factor of 0.97).
What is HRRP in healthcare?
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.