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CMS Hospital Readmission Penalties And Their Looming Unintended Consequences

Beginning next year, if you or your loved one is discharged from a hospital, you’d better not return to it for 30 days. That’s because the hospital may be fined for your readmission (especially if you have had pneumonia, heart failure, or a heart attack – diagnoses singled out by CMS as preventable causes of readmission). In fact, if your readmission happens to tip the scales into the red zone (where the hospital falls below the 75th percentile in its hospital readmission rate compared to other hospitals), your arrival could literally cost them millions of dollars in penalties. Needless to say, hospitals are now scrambling to put programs in place to reduce hospital readmissions, all for the sake of “improved quality of care.” In summary:

“One in five Medicare inpatients is readmitted within 30 days. The Centers for Medicare and Medicaid Services (CMS) considers 40%-75% of these readmissions to be preventable. In October 2012, CMS will begin to track readmission and impose financial penalties on hospitals with higher–than–expected readmission rates for certain conditions. Other payers will certainly follow.”

So, will these programs to reduce hospital readmissions improve the quality of care you receive at your local hospital? Forgive me if I remain skeptical.

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