What is the Medicare readmission penalty?

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.

What is the 30-day readmission rule?

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 are readmission penalties calculated?

The penalties were calculated by subtracting each adjustment factor from 1 and turning it into a percentage. Thus, a hospital losing the most money because of its high readmission rate (which CMS gave an adjustment factor of 0.97) is listed by KHN as receiving a 3 percent penalty.

Does Medicare pay for readmissions?

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.

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

heart failure
A study of Medicare patients hospitalized for heart failure in 225 hospitals found that rates of readmission within 30 days were highest for patients discharged from the quartile of hospitals with the lowest percentage of patients seen for follow-up within seven days of discharge [51].

What is the Medicare 30 day rule?

The Medicare 30 day window is in place to allow a beneficiary access to remaining skilled days after a period of non-skilled level without requiring another 3 day qualifying hospital stay.

What are the three exceptions to the Medicare 72 hour rule?

There are a few exceptions to Medicare’s policy cited below: Clinically unrelated services are not subject to the three-day window policy, if the hospital can attest that the services are distinct or independent from a patient’s admission. Ambulance services and maintenance renal dialysis services are also excluded.

Do hospitals pay for readmissions within 30 days?

Since the start of the program on Oct. 1, 2012, hospitals have experienced nearly $1.9 billion of penalties, including $528 million in fiscal year (FY) 2017. In FY 2013, payment penalties were based on hospital readmissions rates within 30 days for heart attack, heart failure and pneumonia.

What is an acceptable readmission rate?

The standard benchmark used by the Centers for Medicare & Medicaid Services (CMS) is the 30-day readmission rate. Rates at the 80th percentile or lower are considered optimal by CMS. Patients transferred to another hospital for longer term care won’t count as a readmission.

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

What diagnosis has the highest rate of readmission?

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 is a good hospital readmission rate?