Healthcare News & Insights

Lawmakers to CMS: HRRP doing more harm than good for hospitals

A group of 34 lawmakers on Capitol Hill are urging the Centers for Medicare & Medicaid Services (CMS) to work with Congress to ensure the Hospital Readmissions Reduction Program (HRRP) doesn’t harm hospitals that serve the poor. 177005692

The bi-partisan group of U.S. Representatives, led by Rep. James Bernacci (R-OH), wrote in a June 10 letter to the department of Health and Human Services (HHS) Secretary Sylvia Matthew Burwell that the HRRP program, mandated by the Affordable Care Act (ACA), is doing more harm than good for hospitals treating the nation’s sickest and poorest population.

The program, the legislators wrote, is unfairly penalizing hospitals who care for low-income or dual-eligible beneficiaries (people eligible for both Medicare and Medicaid) who often find themselves readmitted for reasons unrelated to their original cause of admission.

Lawmakers say the sick and vulnerable are often readmitted to the hospital, not because of the quality of care they received, but because making a successful transition home after discharge is anything but easy.

Spike in readmissions

Fewer and lower quality primary care and social services in low-income neighborhoods increases the likelihood of a patient getting readmitted within 30 days after discharge, the lawmakers said.

The HRRP penalty may have incentivised hospitals to reduce readmissions by scheduling follow-up visits utilizing case managers and providing better post-acute care coordination, the lawmakers wrote, but socio-economic factors affecting low-income patients which are outside of a hospital’s control are hampering their efforts.

New bill evens playing field

Bernacci has introduced a bill, the Establishing Beneficiary Equity in the Hospital Readmission Program (H.R. 4188), which  allows for adjustments in penalties for hospitals serving a large percentage of Medicaid and Medicare beneficiaries. The legislation also excludes levying penalties against hospitals for patients that are readmitted because of certain extenuating circumstances.

Adjusting the penalty, the legislators wrote, like separately reporting different dual-eligibility readmission rates, will account for the disparities in the patient population and can make a big difference to hospitals who serve the nation’s 9 million Medicare and Medicaid patients.

According to Bloomberg, providers want to improve quality and save Medicare money, but they don’t want to be unfairly penalized. For example, each readmission above the average in 2015 costs from $33,000 for a patient readmission after COPD treatment to $285,000 for each readmission after a hip or knee replacement.

“Reducing readmissions cannot be placed squarely on the shoulders of the hospitals,” the lawmakers wrote. “It is a shared responsibility that involves the hospital, the patient, social services professionals and providers across the continuum of care. With the penalty set to increase from a 2% reduction to a 3%  reduction on every patient stay payment, we urge CMS to work with Congress to ensure the program isn’t negatively impacting hospitals that service dually-eligible beneficiaries.”

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