Healthcare News & Insights

Lawmakers turn-up pressure on CMS to reform HRRP

Federal regulators are being squeezed by Washington lawmakers to fix an Obamacare program that they say may be unfair to low-income patients and the safety-net hospitals that serve them.

466442319Legislators from both sides of the aisle have joined forces to even the playing field when it comes to calculating hospital readmission penalties.

A bi-partisan Senate bill introduced this month wants the Centers for Medicare & Medicaid (CMS) to take into account the financial status of patients before calculating readmission fines, according to Kaiser Health News.

The action follows a plea to CMS by a bi-partisan group of 34 U.S. Representatives earlier this month to work with Congress to ensure the Hospital Readmissions Reduction Program (HRRP) mandated by the Affordable Care Act (ACA) doesn’t harm hospitals that serve the poor.

Safety-net hospital unfairly penalized

The Senate’s Hospital Readmission Accuracy and Accountability Act addresses growing concerns that hospitals, particularly safety-net hospitals often located in urban centers, and serve the nation’s poor and vulnerable populations are unfairly penalized under HRRP.

Low-income patients often lack the support to keep them out of the hospital and help them become healthier because of a variety of factors like a lack of primary care providers, difficulty following discharge instructions, poor living conditions and limited community resources.

The bill leaves it up to CMS as to how best to factor patient finances into readmission penalties.

A similar bill to eliminate inequities in HRRP was introduced in the Congress by Rep. James Bernacci (R-OH). It allows for adjustments in penalties for hospitals serving a large percentage of Medicaid and Medicare beneficiaries and excludes levying penalties against hospitals for patients that are readmitted because of certain extenuating circumstances.

Even when hospitals provide high-quality, patient-focused care, those hospitals that take care of a large numbers of low-income patients consistently have higher readmission rates, according to a statement by the bills’ sponsors, Sens. Joe Manchin (D-WV), Roger Wicker (R-MS), Mark Kirk (R-IL) and Bill Nelson (D-FL).

Hospitals and docs pushing for passage

The bill has garnered a ring of endorsements including The American Hospital Association (AHA) and the American Medical Association (AMA).

“This is one way I think we can improve our health care system,” said Sen. Nelson. “If you’re going to judge a hospital on re-admissions, you should have to take into account, for example, whether it treats more folks who can’t afford or don’t have access to quality care after being discharged.”

Hospitals may see their Medicare payments slashed up to 3% in 2015 as Medicare expands the number of conditions it bases its readmission assessments on to include chronic obstructive pulmonary disorder (COPD), and hip and knee replacements.

In the meantime, many hospitals hit with readmission penalties are working hard to coordinate care among high-risk patients by partnering with community healthcare agencies to help patients with medication management and follow-up visits.

“We need to be improving access and quality of care based on what the patient needs, not penalizing providers and patients on the basis of a one-size fits-all government policy,” Sen. Kirk said.

Medicare does have ways to adjust penalties among healthcare facilities by factoring in the seriousness of a patient’s condition. However, the HRRP doesn’t give regulators any wiggle room to take a patient’s finances into account when calculating readmission penalties.

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