Hospitals face reimbursement penalties from the Centers for Medicare & Medicaid Services (CMS) based on readmissions.*
Here’s what the numbers tell us.
The diagnosis of chronic obstructive pulmonary disease (COPD), heart failure (HF) and pneumonia continue to be the highest overall readmission areas in the penalty program. (Note: The pneumonia diagnosis definition was expanded in the 2017 penalty year.) Also measured are: acute myocardial infarction (AMI), coronary artery bypass graft (CABG), total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- Facilities with fewer than 200 beds are penalized at a higher rate than larger facilities.
- Urban facilities are seeing a higher rate of penalty than rural hospitals.
- Higher penalties are noted in the Southeast region as opposed to other regions across the map. This may be attributed to a higher-than-average Medicare population in these facilities/regions. (Medicare is the primary insurer for patients over 65 years old.)
*The penalties applied to each hospital’s Medicare payments in 2019 are based on readmissions from July 1, 2014 to June 30, 2017. Penalties applied in 2020 are from July 1, 2015 to June 30, 2018. By law, CMS must grade performance based on a curve.
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