In fiscal year 2017, CMS will withhold $528 million in Medicare reimbursements to hospitals with higher-than-expected readmission rates as part of the Hospital Readmissions Reduction Program, reports Kaiser Health News.
This is the fifth year of the Hospital Readmissions Reduction Program. The federal agency released this year's results Tuesday. CMS examined hospitals' 30-day readmission rates for seven conditions: heart attacks, heart failure, pneumonia, chronic lung disease, hip and knee replacements and coronary artery bypass graft surgery. This is the first time in the five years of the readmission reduction program that CABG surgery was included in the tally.
To determine fines, CMS used patient data from July 2012 to June 2015. For each hospital, it compared a hospital's reported readmission rate to what CMS determined was a reasonable readmission rate, based on national rates and demographic health.
Hospitals with more unplanned readmissions than expected will receive a reimbursement reduction for each Medicare case during the upcoming fiscal year, which runs Oct. 1 through September 2017.
Below are five statistics.
1. Medicare expects hospitals' penalties to total $528 million in 2016, about $108 million more than last year.
2. CMS will penalize 2,597 facilities in FY 2017, five more hospitals than last year.
3. According to KHN's analysis, 1,621 hospitals have faced penalties every year in the five years of the program.
4. Forty-nine hospitals will receive the maximum reduction in reimbursement, or 3 percent of the Medicare rate. That is up from 38 hospitals that received the largest penalty last year.
5. The average reduction to hospitals was 0.73 percent for each Medicare payment, up from 0.61 percent last year.