82 Percent of Hospitals Penalized for High Readmissions

FJ Thomas

Sarasota, FL (WorkersCompensation.com) – Discharge from the hospital after an extensive surgery or injury takes a lot of coordination and planning, especially if the outcome is going to be successful, readmissions avoided, and costs contained. While variations of the bundled payment programs in the commercial and Medicare world have been a successful at keeping costs down, a new report from Kaiser on readmission penalties suggests there is still a lot of work to do.

According to a Medpac report, taking overall health conditions into account, readmission rates dropped from 2008 to 2017. During that time, readmission rates for heart patients and pneumonia cases had an average decrease of 4.23 percent. Other categories such as knee replacement, and chronic obstructive pulmonary disease saw decreases as well, although analysts speculated overall patient health may have played a role.

A total of 2,499 hospitals, equating to 47 percent of all facilities, will receive reduced payments through September of next year due to high readmission rates. The average penalty is a .64 percent reduction in payment for every Medicare patient. According to a 2018 analysis from Congress, the average readmission penalty is $218,000 per hospital. In this round of penalties, CMS estimates their overall savings at $521 million.

Total of 39 hospitals received the maximum penalty of 3 percent. Texas had the highest number of hospitals with a 3 percent penalty at a total of 7 hospitals, followed by Kentucky with 6 hospitals. A total of 152 hospitals had no penalty the previous year, but assessed a penalty for 2022. Magee hospital located in Pennsylvania, had the highest increase in penalty percentages, going from .4 percent penalty last year to 2.84 percent penalty for this year. Advocate Broman Medical Center in Illinois also saw a drastic increase, going from .45 percent penalty last year to 2.59 percent penalty this year. Of those that did have a penalty the previous year, Edgewood Hospital in Pennsylvania saw the largest decrease in penalties, from 2.19 last year to .11 this year

The facilities that were excluded from the readmission penalty review were pediatric, veteran, psychiatric, rehabilitation and long-term care hospitals. Acute care facilities were excluded as well since they are the only source of care for their area. The facilities excluded totaled 2,216, leaving 3,046 eligible hospitals of which 82 percent received a penalty.

A hospital search tool is available on the Kaiser website.