Readmission Penalties Given by Centers of Medicare & Medicaid Services

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According to a May 2012 news release from the American Heart Association, the Centers for Medicare and Medicaid Services (CMS) plans to give readmission penalties to hospitals with high readmission rates related to heart failure, heart attacks, and pneumonia in order to cut costs. However, research shows differences in regional hospital readmission rates have more to do with socioeconomic factors than with hospital performance or degree of patient illness. This is according to research presented at the American Heart Association’s Quality of Care & Outcomes Research Scientific Sessions in 2012.

Next year, hospitals with higher-than-average 30-day readmission rates will face reductions in Medicare payments. This research suggests the CMS' current plans to penalize hospitals are not appropriately targeting the root of the source; they are currently focused on penalizing hospitals individually, when they should be looking to improve community health as a whole. “We have to find ways to help hospitals and communities address this problem together, as opposed to putting the burden on hospitals alone. We need to think less about comparing hospitals to each other in terms of their performance and more about looking at improvement in hospitals and communities,” says Karen E. Joynt, M.D., lead author of the study and an instructor at Brigham and Women’s Hospital in Boston, Mass.

U.S. regional readmission rates relating to heart failure vary from 10 percent to 32 percent, according to the research. Communities with higher rates are likely impoverished, research shows, with more physicians and hospital beds available, possibly accounting for the spike in readmission rates. 

This research indicates a more broad approach needs to be taken outside of hospital-specific regulations and penalties, providing care and opportunity for communities as a whole to reduce high readmission rates. 

©iStockphoto.com/Marcela Barsse

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