Fine to Hospitals for Excessive Readmissions May Punish the Wrong Facilities

hospitalPenalizing hospitals for hospitalized relapses of patients who suffer from chronic lung disease may have a greater impact on facilities that are dedicated to providing care to poor and minority patients, according to specialists from the University of Michigan. The analysis follows an announcement from the federal government to fine hospitals due to the number of Medicare patients being readmitted to the hospital 30 days after discharge.

Last week, the Centers for Medicare & Medicaid Services (CMS) announced that it had decided to fine more than 2,600 medical facilities based on concerning, new statistics revealing that an average of one in every five Medicare patients need to be readmitted to hospitals less that 30 days after the first visit.

The CMS has been reducing Medicare and Medicaid payments to facilities they consider as having excessive readmission rates for registered patients who suffered heart failure, heart attack, or pneumonia since 2012. Now, the CMS is also including penalties for readmissions regarding surgeries for hip and knee replacements, as well as chronic obstructive pulmonary disease (COPD) in its Hospital Readmission Reduction Program.

However, the University of Michigan conducted an analysis, which was recently published in The American Journal of Respiratory and Critical Care Medicine, which studies the effects of the penalties on COPD patient care. The researchers examined data from more than 3,000 hospitals that provide healthcare for patients suffering from COPD for three years, and concluded that the penalties will disproportionately punish more teaching and safety-net hospitals.

“We worry that this policy may cause more harm then good,” explained one of the authors of the study, Michael Sjoding, M.D., a pulmonary and critical care fellow in the U-M Medical School’s Department of Internal Medicine. “Medicare is trying to improve patient care and reduce waste, but the hospitals they are penalizing may be the ones who need the most help to do so.”

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According to the study, because teaching hospitals and safety-net hospitals are the ones that will bear the largest financial penalties, the researchers are concerned about the outcomes of the decision, since these facilities often provide care to poor or medically complex patients suffering from COPD who are also higher-risk patients for readmissions due to socioeconomic and other health factors.

The CMS’ Hospital Readmission Reduction Program is designed to encourage hospitals to improve healthcare quality and reduce readmissions for a number of selected diagnoses through financial incentives and punishments. However, the investigators drew attention to the fact that there are other reasons outside the hospitals’ control that may cause readmission, making some of the CMS penalties unfair.

“If patients can’t afford medications, or have unstable housing situations, they may end up being readmitted to the hospital. No interventions to date have effectively and sustainably reduced COPD readmissions, so it’s unclear what a hospital can do to prevent them,” stated Sjoding, suggesting changes in the policy itself in order to improve care and not punish the patients.

The COPD Foundation also recently launched a program designed to reduce hospital readmissions caused by COPD exacerbations or flare ups, with the help of academics, healthcare providers and industry leaders. Dubbed the COPD Praxis program, which stands for Prevent and Reduce COPD Admissions through expertise and Innovation Sharing, the foundation is planning on hosting the 2nd Readmission Summit next year to discuss it.

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