Healthcare News & Insights

Readmission rates: CMS offers hospitals help in lowering them

There’s good news and bad news for physicians in the final Medicare physician-fee schedule for 2013 issued by the Centers for Medicare & Medicaid Services (CMS). Let’s start with the good news: Hospitals will be getting help from primary care physicians (PCPs) to lower readmission rates.

The new policy will actually pay PCPs to coordinate patients’ care in the 30 days following a hospital or skilled nursing facility stay. This will be the first time physicians will receive a separate payment to help patients with their transition back to the community following a discharge. Now, there’s an incentive for physicians to see their patients who’ve been hospitalized.

By doing this, CMS is recognizing the importance of the work community physicians do to keep patients healthy after being discharged from a hospital or skilled nursing facility. By paying PCPs for specifically coordinating care after a hospitalization, it ensures better continuity of care and will — in the end — help reduce patient readmissions for hospitals.

This change along with other changes in the rule are expected to increase payment to PCPs anywhere from 3% to 7%, if Congress averts the statutorily required reduction in Medicare’s physician fee schedule.

But don’t worry. Even though the rule requires a 26.5% across-the-board reduction to Medicare payment rates under the Balanced Budget Act, this has been averted by Congress every year since 2003.

Medicaid pay increase

Additionally, starting in January, family physicians, internists and pediatricians will be paid a higher Medicaid rate for two years. This is being done to encourage more physicians to accept Medicaid patients.

The new provision will pay PCPs the same rates they get for treating Medicare patients for treating Medicaid patients. While Medicaid rates vary by state, they’re generally way below those paid by Medicare and private plans.

“The health care law will help physicians serve millions of Americans across the country,” Kathleen Sebelius, Health and Human Services (HHS) secretary, said in a press release. “By improving payments for primary care services, we are helping Medicaid patients get the care they need to stay healthy and treat small health problems before they become big ones.”

Even though the pay hike goes into effect in January, states have until March 31 to file paperwork with CMS to explain how they’ll pay the money.

Bad news

However, while PCPs are pleased with the new pay hike, some specialists — many of which are employed in hospital settings — aren’t happy at all.

OB/GYNs, radiologists, pathologists, neurologists and emergency department doctors, who asked to be included in the final rule, were left out.

The final rule with comment period will appear in the November 16 Federal Register.

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