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CMS Data Points to U.S.-Wide Reduction in Avoidable Hospital Readmissions

September 14, 2016
by Rajiv Leventhal
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New data from the Centers for Medicare & Medicaid Services (CMS) released on Sept. 13 shows that between 2010 and 2015, hospital readmission rates fell by 8 percent nationally.   

The data, revealed in a blog post written by Patrick Conway, M.D., principal deputy administrator and chief medical officer, CMS; and Tim Gronniger, deputy chief of staff, CMS, showed that all states but one have seen Medicare 30-day readmission rates fall in that five-year span. The one state that did not lower readmission rates was Vermont, as its rate increased slightly from 15.3 percent in 2010 to 15.4 percent in 2015. What’s more, in 43 states, readmission rates fell by more than 5 percent; in 11 states, readmission rates fell by more than 10 percent, according to the CMS data.

To address the problem of avoidable readmissions, the Affordable Care Act (ACA) created the Hospital Readmissions Reduction Program, which adjusts payments for hospitals with higher than expected 30-day readmission rates for targeted clinical conditions. Hospitals will get fined for failure to meet the criteria of CMS’ focus on six conditions: heart attack, congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), elective hip and knee replacements, and for the first time this year—coronary artery bypass graft surgery.

The data from CMS comes at an interesting time, just a few months after a Kaiser Health News report found that the federal government’s penalties on hospitals for failing to lower their rehospitalization rates have hit a new high, as Medicare will withhold approximately $528 million—about $108 million more than last year. Indeed, the government will punish more than half of the nation’s hospitals — a total of 2,597 —having more patients than expected return within a month.

While that is about the same number penalized last year, the average penalty will increase by a fifth, according to a Kaiser Health News (KHN) analysis. For each hospital, the government calculated how many readmissions it expected, given national rates and the health of each hospital’s patients. Hospitals with more unplanned readmissions than expected will receive a reduction in each Medicare case reimbursement for the upcoming fiscal year. The new penalties will take effect in October, and the maximum reduction for any hospital is 3 percent.

That KHN report did note however that since the Hospital Readmissions Reduction Program began in October 2012, national readmission rates have dropped. But according to the KHN report’s author, Jordan Rau, “The penalties are the subject of a prolonged debate about whether the government should consider the special challenges faced by hospitals that treat large numbers of low-income people. Those patients can have more trouble recuperating, sometimes because they can’t afford their medications or lack social support to follow physician instructions, such as reducing the amount of salt that heart failure patients consume. The Centers for Medicare & Medicaid Services says those hospitals should not be held to a different standard.”

Nonetheless, per the new CMS data, across states, Medicare beneficiaries avoided approximately 100,000 readmissions in 2015 alone, compared to if readmission rates had stayed constant at 2010 levels. “That means Medicare beneficiaries collectively avoided nearly 100,000 unnecessary return trips to the hospital. Cumulatively since 2010, the HHS Assistant Secretary for Planning and Evaluation estimates that Medicare beneficiaries have avoided 565,000 readmissions,” the CMS blog post read.

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