how much is medicare from hospital readmissions using home health?

by Dr. Brody Roob Published 3 years ago Updated 2 years ago

What is the hospital readmissions reduction program (HRRP)?

What is 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.

How much does Medicare pay for home health care?

Your costs in Original Medicare $0 for home health care services. 20% of the Medicare-approved amount for Durable Medical Equipment (DME). Before you start getting your home health care, the home health agency should tell you how much Medicare will pay.

What are unplanned readmissions to the hospital?

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. Readmissions to any applicable acute care hospital are counted, no matter what the principal diagnosis was.

Does Medicare pay for 24 hour care?

Medicare doesn't pay for: 1 24-hour-a-day care at home 2 Meals delivered to your home 3 Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need 4 Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need

Does Medicare cover hospital readmissions?

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 Medicare readmission rate?

16.9 percentThe overall readmission rate was 14.0 per 100 index admissions, with Medicare stays having the highest readmission rate (16.9 percent) and privately insured stays having the lowest readmission rate (8.7 percent).

How can home health reduce hospital readmissions?

As part of an overall strategy to stabilize (in particular) vulnerable patients, a Home Health partnership can improve patient satisfaction, medication and therapy compliance, and post-discharge outcomes—ultimately reducing hospital readmissions.

What percentage of Medicare beneficiaries discharged from a hospital is readmitted within 30 days?

New Study: 20 Percent of Hospitalized Medicare Patients Readmitted To Hospital Within 30 Days; Half Rehospitalized Without Seeing a Doctor After Discharge.

What is the CMS penalty for readmission?

For the readmission penalties, Medicare cuts as much as 3 percent for each patient, although the average is generally much lower. The patient safety penalties cost hospitals 1 percent of Medicare payments over the federal fiscal year, which runs from October through September.

Why are hospital readmissions so costly?

Optimize transitions of care Ineffective care transitions following a hospitalization increase the rates and costs of hospital readmissions. Inadequate care coordination, such as lackluster care transition management, accounted for $25 to $45 billion in wasteful spending in 2011, Health Affairs reported.

What is the post acute care transfer policy?

Transfers to a Home with Home Health Services Medicare's IPPS post-acute care transfer policy requires hospitals to apply the correct discharge status code to claims where patients receive HH services within 3 days of discharge. This includes the resumption of HH services in place prior to the inpatient stay.

What are readmission rates?

Percentage of admitted patients who return to the hospital within seven days of discharge. The percentage of admitted patients who return to the hospital within seven days of discharge will stay the same or decrease as changes are made to improve patient flow through the system.

What diagnosis has the highest 30 day readmission rate for Medicare patients?

Among these most frequent conditions, the highest readmission rates were seen for congestive heart failure (24.7 percent), schizophrenia (22.3 percent), and acute and unspecified renal failure (21.7 percent). In other words, for these conditions over one in five patients were readmitted to the hospital within 30 days.

What effect does unnecessary hospital admissions and readmissions have on Medicare?

About 1 in 5 Medicare patients is readmitted within 30 days of discharge from a hospital. Unplanned readmissions cost Medicare $17.4 billion per year. Up to 20% of patients discharged from an acute care hospital suffers an adverse event within 3 weeks, 75% of which are considered potentially preventable.

What Are the Leading Risk Indicators?

Ann Meadow, ScD, was a Social Science Research Analyst (Retired) with the Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, Maryland.

Abstract

A large sample of all 2011 home healthcare users in traditional Medicare was analyzed to identify the risk indicators at start-of-care that were associated with the highest probability of readmission (N = 597,493).

How much higher is readmission rate for Medicare?

The study, published this week in JAMA Internal Medicine by researchers at the University of Pennsylvania, found that Medicare patients discharged to home health had a 5.6% higher 30-day readmission rate compared with patients sent to a skilled-nursing facility, or SNF.

Why do home health agencies report more hospital readmissions?

Home health agencies likely report more hospital readmissions because they don't benefit from around the clock care available in the SNF setting , Werner said.

Does home health save Medicare?

Home health saves Medicare money despite higher readmissions. Home health agencies are more likely to experience hospital readmissions compared to skilled-nursing facilities, but their lower service costs still make them a cheaper post-acute care option, according to a new analysis.

Does Medicare pay for home health visits?

Right now, Medicare only pays for one home health visit per day, so the agencies are limited in the extent of services they can provide. If CMS were to expand the number of home health visits it pays for daily, home health agencies could provide more comprehensive services to patients and prevent readmissions.

How many elderly patients will be readmitted in one month?

January 18th, 2019. |. Following a hospital discharge, a staggering 1 in 5 elderly patients will be readmitted within one month. Medicare seeks to lower these high 30 day readmission rates by encouraging home based care from qualified home care agencies in an effort to reduce avoidable readmissions and improve overall care outcomes.

Why is hospitalization at home not widely embraced?

The reason why this has not been widely embraced in the United States is that there was no way to bill Medicare for these healthcare costs.

What are the risks of hospitalization for older patients?

These include hospital acquired infections, falls, changes in mental status, delirium and a noteworthy decline in overall patient function.

What is HRRP in Medicare?

The CMS readmission program, called Hospital Readmission Reduction Program or HRRP, is a value-based purchasing program for Medicare that can drastically reduce important payments made to hospitals that show excessive higher avoidable readmissions.

Is home based healthcare rising?

Home based healthcare is expected to rise higher as care agencies adapt to these changes by hiring more healthcare professionals such as physical and occupational therapists, social workers, nurses and certified nursing assistants.

How long does it take for an unplanned readmission to happen?

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 ...

Medicare, Reimbursement Models, and the Hospital Readmission Reduction Program

High levels of readmissions after a hospital stay reflect low quality and non-continuity within U.S. healthcare production. Past and current data indicate that readmissions are prevalent under fee-for-service reimbursement models (Young and Kroth 2018, 99).

Home Health Partnerships as a Post-Acute Care Strategy

Home Health partnerships offer an array of benefits, including patient-centered care and communication. As a strategy for reducing waste, a Home Health partnership can decrease preventable emergency department and in-patient visits in addition to the delivery of high-touch patient support.

How much did Medicare pay for readmissions in 2015?

The same post offered that in 2015 one in five elderly patients was readmitted to the hospital within 30 days of discharge, costing Medicare some $15 billion per year. Some of the things we know about readmissions include: Hospitals that staff for manageable nurse workloads have lower levels of readmissions.

How does readmission affect revenue?

Readmissions have a negative impact on revenue, due to penalties charged by CMS and other payers. Hospitals in the highest quartile for quality typically have lower readmission rates. HealthStream shared in an earlier post that hospitals caring for the neediest patients are likely to pay readmission penalties.

What is the emotional toll of readmission?

When it comes to the emotional toll of readmissions, it is important to understand how rarely patients and direct caregivers have been asked about the process. One study showed that patients often felt that their readmissions were preventable and linked them to issues with “discharge timing, follow-up, home health and skilled services” (Smeraglio et al., 2019). It’s not hard to imagine the frustration that could be the result of this perceived failure. At the same time, the care providers involved failed to recognize their potential role in the readmission. The same article mentions that “review by a RN case manager found in 49% of readmissions the hospital system had some amount of opportunity to improve the discharge process. The RN case managers more often agreed with the patient’s perspective of readmission than the provider’s” (Smeraglio et al., 2019). Here again, the emotional toll of a care workplace with inadequate support and high patient volumes might cause some of the problems in discharge planning, care transitions, and patient education.

Why are readmissions a target?

In the efforts of CMS (Centers for Medicare & Medicaid Services) to control expenditures for care, readmissions are a target, because they involve a patient’s return to the most costly care possible, inpatient hospital care.

Does HRRP count ED visits?

While research shows national readmission rates have fallen since the program took effect, some experts note that HRRP does not count ED visits or observation stays as readmissions, and question whether readmissions actually decreased or if hospitals are avoiding admitting Medicare patients” (Advisory Board, 2019).

Does Medicare readmissions count as ED visits?

The cost of hospital readmissions is enormous, estimated to be in the vicinity of $26 billion annually (Wilson, 2019), so it’s no wonder Medicare is working to reduce this amount. According to the Advisory Board, “In FY 2019, 82% of hospitals in the program received readmissions penalties. While research shows national readmission rates have fallen since the program took effect, some experts note that HRRP does not count ED visits or observation stays as readmissions, and question whether readmissions actually decreased or if hospitals are avoiding admitting Medicare patients” (Advisory Board, 2019). The same article suggests that hospitals may have changed their tactics, leading to a sizeable increase in treat-and-discharge visits to the ED or observation stays, which do not count as readmissions. A study of more than three million hospital stays from 2012 to 2015 “found that the total number of 30-day return visits to the hospital—which included ED visits and observation stays—per 100,000 discharges increased by 23 visits per month” (Advisory Board, 2019), even as official readmissions decreased by 23 visits per month. This unintended consequence, of using ED visits and observation status stays, may be shifting more financial obligations to patients or at least preventing hospitals from being penalized to the same degree.

Medicare Blog