Healthcare News & Insights

Medicare to penalize hospitals for unnecessary readmissions

Beginning in late 2012, hospitals will be penalized for unreasonably high readmission rates for patients treated for pneumonia, heart attacks and heart failure.

The Department of Health and Human Services (HHS) will calculate hospital-specific expected readmission rates based on individual patients’ characteristics. Hospitals that exceed their expected rates will lose up to 1% of their Medicare payments in the first year. The amount of the penalty will increase to 2% the following year, and 3% the year after.

According to a study published in the New England Journal of Medicine, about one fifth of patients make repeat visits. Readmissions cost the U.S. healthcare system over $17 billion a year and result in lower quality treatment and higher cost to taxpayers according to The Centers for Medicare & Medicaid Services.

Why so many readmissions? Often, it’s because hospital staff members failed to provide detailed and clear care instructions prior to discharge, according to experts quoted in a recent Washington Post article. Patients sometimes return home without a comprehensive understanding of the diagnosis, treatments, follow-up care and possible negative reactions.

Those experts recommend doctors and administrative staff always encourage patients to:

  • Ask a lot of questions. Patients should understand all prescribed medications, the treatments they received, how to care for themselves properly and what symptoms to look for if something goes wrong.
  • Follow-up with their regular doctor.
  • Know who to contact with questions or for test results.

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