Fri. Nov 27th, 2020

once again, Most hospitals in the country are being punished by Medicare for frequently returning patients within a month of discharge – this time causing a combined $ 420 million loss, government records show.

In the fourth year of the federal reading penalty, 2,592 hospitals will receive a lower payment for each Medicare patient who remains in the hospital – starting in October or not – to be readmitted. Hospital Reading Reduction Programmanufactured by Affordable Care Act, Hospitals were designed to pay attention to what happens to their patients after being discharged.

National reading rates have declined since the introduction of fines, but one out of every five Medicare patients sent to the hospital returns within a month.

Some hospitals consider penalties unfair because they can lose money even if they are less educated than they were in previous years. All but 209 of the hospitals punished during this period were punished according to an analysis of Kaiser Health News records found last year.

The penalty is based on readymades between July 2011 and June 2014 and includes Medicare patients who were originally hospitalized for one of five conditions: heart attack, heart failure, pneumonia, chronic lung function. Problems or optional hip or knee replacement. For each hospital, Medicare determined what the appropriate number of reagents should be based on the mix of patients and how the hospital industry performed. If the number of readmissions for that launch was up, Medicare fined the hospital.

The penalty will be applied towards medical payments when the federal fiscal year begins in October. In this round, the average Medicare payment reduction is 0.61 percent per patient stay, but 38 hospitals will receive a maximum 3 percent reduction, a KHN analysis shows. A total of 506 hospitals, including those facing the maximum penalty, will lose 1 percent or more of their Medicare payments.

These reduced payments will affect three-quarters of hospitals or more in Alabama, Connecticut, Florida, Massachusetts, New Jersey, New York, Rhode Island, South Carolina, Virginia, and the District of Columbia. KHN found that less than a quarter of hospitals face convictions in Idaho, Iowa, Kansas, Montana, Nebraska, North Dakota and South Dakota.

The majority of 2,232 hospitals were penalized this year, not because Medicare found the institutions it studied to be sufficiently inconsistent, but because they were automatically exempted from being evaluated – either because They were specialized in certain types of patients, such as the elderly or children, because they were specially designated “critical access” hospitals, or because they had very few cases for accurate assessment of Medicare.

This year, there is no penalty for hospitalized fines. As happened last year, Medicare is also offering bonuses and penalties based on various quality measures. The government has not announced those yet, but they begin in October. Those financial incentives would total $ 1.5 billion. Medicare will penalize hospitals with high rates of infection and other avoidable incidents of patient harm.

The KHN analysis found that four hospitals received the maximum readable penalty each year. Two are in Kentucky: Harlan ARH Hospital, which is in the center of the Appalachian Coalfields, and Monroe County Medical Center in Tomkinsville. Other hospitals are also in Livingston, Tennessee, Regional Hospital – Appalachia – and none of the hospitals at Franklin Medical Center in Winnsboro, Louisiana, immediately return the call on Monday.

Hospitals have advocated for both Medicare and Congress to take into account the socio-economic background of patients when assessing reading penalties. He argues that some factors for readymades – such as whether patients can afford drugs or healthy food – are beyond their control.

The Medicare Payment Advisory Commission, which advises Congress, Is recommended Change in reading penalty. The National Quality Forum, a nonprofit that appears when creating the Medicare Quality Matrix, Is investigating Should socio-economic factors be included when calculating reading admission measurements as well as other barometers of hospital quality. But that experiment will take two years to complete.

“Sensors should not be punished simply because of the demographic characteristics of their patients,” censored. Joseph Manchin III, DW.Va. And Roger Wicker, R-Miss., Recently written In Journal of the American Medical Association. Senators have Introduced a bill To consider socio-economic factors while calculating punishment.

A health policy analyst, Drs. His essay, written by Andrew Boozeri, pointed to a study that found security-hospitals were about 60 percent more likely than other hospitals to be punished in all penalties in the first three years. . The essay states that hospitals with the lowest benefits are 36 percent more likely than those with better financial size.

In Issued rules On July 31, the Centers for Medicare and Medicaid Services reiterated that it would not make such changes to the unilateral program, noting that some safety-net hospitals are able to keep their readmission admission rates low.

The agency wrote in the rule, “While we appreciate the importance of these comments and the role of sociopolitical status,” we said, “We continue to worry about placing hospitals on various standards for the outcomes of our patients . ” Sociological status quo because we do not want to reduce potential incentives or reduce incentives to improve outcomes for the disadvantaged. “

KHN’s coverage of aging and long-term care issues is supported in part by the grant Scan foundation.

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