Reducing Avoidable Readmissions By Improving Transitions In Care
Section 3025 of the 2010 Affordable Care Act (Public Law 111-148) required the HHS to establish a Hospital Readmissions Reduction Program that would reduce payments to hospitals for excess readmissions. This new ruling took affect October 1, 2012.
What’s The Financial Impact
- 65% percent of eligible hospitals will be penalized. That equates to 2,215 eligible hospitals that will see a reduction in reimbursement.
- A total of 3,399 hospitals are subject to the HRRP. The HRRP was designed to apply only to subsection (d) hospitals. Subsection (d) hospitals are basically the short-term acute care hospitals typically reimbursed by DRG.
278 hospitals will face the maximum payment reduction. Penalties for 2013 are capped at 1%. The cap increases to 2% in 2014 and 3% in subsequent years.
Total penalties are estimated at $345M. CMS stated that total penalties would be approximately $280M, we estimate this to higher.
The average penalty for penalized hospitals is approximately $200,000. The minimum penalty is a few hundred dollars. However, the maximum penalty for a single hospital is $3.9M.
Pneumonia and heart failure make up the most penalties. Penalties are spread reasonably across all three initial conditions and heart attack accounts for fewer penalties.
As you can see, the penalties are far reaching and of an incredibly large magnitude. Actions should be taken to significantly and sustainably minimize or even eliminate readmissions and penalties. These actions will not only improve your hospital’s finances but it will improve the quality of care, placing your organization in a strong position for the new pay-for-performance methodology.
Nurse Follow-Up programs provided by IntellaTriage can help to reduce readmissions and save you money by conducting outreach calls after discharge to:
- Clarify discharge instructions
- Allow nurses to educate patients post discharge
- Remind patients to refill their prescriptions
- Have hospital staff alerted to patient issues
- Schedule follow up care appointments.
- Provide nurse triage and advice as appropriate