Bipartisan legislation has been introduced that would require Medicare to consider hospital patients' financial status when deciding whether to punish a hospital for too many readmissions, according to a Kaiser Health News report.
The legislation was introduced to address lawmakers' concern and healthcare organizations' complaint that hospitals serving large numbers of low-income patients are more likely to be penalized under the readmission reduction program, as Medicare currently does not allow regulators to take socio-economic status into account.
The readmission reduction program, which was established by the Patient Protection and Affordable Care Act, took effect in fiscal year 2013. During the first year, CMS cut Medicare reimbursement by up to 1 percent for 2,213 hospitals with high readmission rates for heart attack, heart failure and pneumonia. The second round of penalties started Oct. 1, 2013, and CMS cut reimbursement for 2,225 hospitals in 49 states by up to 2 percent.
According to the reduction program, a readmission occurs when a Medicare patient is readmitted to the same or another acute-care hospital within 30 days of discharge, with certain exceptions such as transfers to another hospital and planned readmissions for chemotherapy, rehabilitation or other treatment. CMS penalizes hospitals for readmissions exceeding a hospital's expected readmission rate, which is the national mean readmission rate risk-adjusted for demographic characteristics and the severity of illness for a particular provider's patients.
In fiscal year 2015, the stakes will get even higher. Hospitals could see their Medicare payments cut by as much as 3 percent, and CMS plans to add chronic obstructive pulmonary disorder and total hip and knee replacement to the program.
The bill is sponsored by Sens. Joe Manchin (D-W.Va), Bill Nelson (D-Fla), Roger Wicker (R-Miss.) and Mark Kirk (R-Ill.).
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