Hospital readmissions have become a serious concern for policymakers. So much so that Medicare established a program geared toward regulating new guidelines for providers to abide by. The Hospital Readmissions Reduction Program was created in 2011 in hopes of easing the burdens of insurance companies from covering excessive amounts of medical payments. As of now, its function is to examine and penalize hospitals for excessive readmission rates of patients who have been diagnosed with expensive conditions to treat. Heart failure, pneumonia, chronic lung problems, heart attacks and elective hip and knee replacements are the conditions examined by the program. According to the Centers for Medicare and Medicaid Services (CMS), approximately 19.6% of hospitalized patients with these ailments are readmitted within 30 days of their discharge date, totaling to $17 billion in yearly expenses. Hospitals and medical facilities that appear to have an overabundance of readmissions for these diagnosis’ have faced deductions in payments for Medicare. As a result of the program’s enforcements, the number of readmissions in hospitals throughout the nation has significantly declined.
Although the program has proved successful, CMS is now focusing on ways to level the playing field for hospitals and clinicians. The group has proposed changes to Medicare’s reimbursement systems, and has requested the feedback of hospitals and medical professionals regarding methods to reduce administrative burdens. If properly implemented, the 21st Century Cures Act will completely change the way hospitals are judged for unnecessary hospital readmissions. Under current regulations, hospitals are penalized if patients are readmitted for the same reason they were originally admitted. However, The group has made some adjustments to take socioeconomic factors into account for each hospital. For example, medical facilities situated in impoverished areas may have high readmission rates due to patients not being able to afford healthier foods or medication. They may also lack transportation or not have the privilege of going to a primary care physician for routine check-ups.
Staff at Henry Ford Hospital in Detroit is experiencing immense difficulties that have drastically affected patient-care outcomes. David Nerenz, the director of Health and Services Research, at the facility says amid these challenges “low household income, reduced access to grocery stores, reduced access to a neighborhood pharmacy, and a greater dispersion of people” has disadvantaged the hospital and its patients under current regulations. The U.S. Census Bureau detailed that about 38% of the Detroit population had an income that fell below the poverty line between 2008 and 2012.
“As we link rewards to penalties, it’s all the more important to understand where these problems come from,” Nerenz said.
CMS has proposed the act to ensure that funds aren’t being taken from the hospitals that need them most. If made into law, it will take effect in fiscal 2019.
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