Case Management

Sneak peek: Readmission penalties expected to affect two-thirds of U.S. hospitals

Case Management Weekly, November 21, 2012

More than two-thirds of U.S. hospitals will face financial penalties associated with avoidable hospital readmissions in 2013, according to Craig K. Lisk, MS. 

And the average hospital will incur penalties totaling $125,000, said Lisk, a staff member at MedPAC, an independent commission that advises Congress on Medicare issues, according to the official transcript of a recent MedPAC Meeting. Lisk was among the speakers. 

CMS began rolling out penalties for preventable hospital readmissions in October. It started small, penalizing hospitals only for readmissions related to three specific conditions: acute myocardial infarction, heart failure, and pneumonia. 

CMS also capped penalties related to avoidable readmissions for 2013, limiting them to 1% of base operating payments. However, the penalty amounts will increase during 2014 and 2015, and CMS will add more conditions to the list, according to Lisk, who was quoted in the official meeting transcript. 

Meanwhile, 17% of hospitals won't see any penalty for avoidable readmissions in 2013, simply because they don't have enough cases for each of the three conditions to qualify, said Lisk. However, 9% of hospitals will reach the maximum penalty in 2013, he said. 

Editor’s note: This article is adapted from an article in the November Case Management Monthly published by HCPro, Inc.

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