The latest CMS reports indicate Medicare fines for hospital readmissions dropped, but nearly 2,300 hospitals were still penalized. The reason for the drop in fines had to do with the chaos of COVID; the government decided to exclude the first half of 2020.
CMS excluded from its calculations Medicare patients who were readmitted with pneumonia across all three years because of the difficulty in distinguishing them from patients with COVID. Despite this, 43% of the nation’s 5,236 hospitals were penalized.
As a home-based care provider, all referral partners have the same goal – how to reduce readmissions and the cost. It’s important to continue to hone in on data that can help your organization better understand your role in preventing readmissions and reducing the cost of care.
Highlights: Overall Conditions with Most Frequent and Costly Readmissions
- In 2018, there were 3.8 million 30-day all-cause adult hospital readmissions, with a 14% readmission rate and an average readmission cost of $15,200.
- Index (initial) admissions for septicemia accounted for the largest number of readmissions overall (8.3%) and by expected payer. Septicemia also had among the highest average readmission costs for Medicaid and self-pay/no charge stays, accounting for approximately 10 and 9%, respectively, of aggregate readmission costs.
- Index admissions for sickle cell trait/anemia had the highest readmission rate overall (36.1%) as well as among Medicare and Medicaid stays (37.2 and 39.4%, respectively).
- Heart failure was among the top five conditions at index admission with the highest number and highest rate of readmissions for Medicaid and self-pay/no charge stays.
- Overall, the highest average readmission cost was for index admissions for complication of transplanted organs or tissue ($27,000), which also had the highest average readmission cost for privately insured stays ($31,200) and the second highest average readmission cost for Medicare stays ($24,200).
Top 20 Principal Diagnosis for 30-day Hospital Readmissions
Source: AHRQ
Lisa Remington is president and publisher of the Remington Report magazine and President of Remington’s Home Care Leadership Think Tank. She has worked with more than 10,000 organizations in both a consultancy role and an educator. Lisa monitors the complex key trends and forces of change to develop a correct strategic approach to de-risk decision-making and create sustainable futures across the healthcare continuum.
Other Articles You Might Enjoy
5 Ways High-Functioning Team-Based Care Reduces Clinician Burnout
Fostering effective team-based care improves both the patient’s and the team’s experience of care delivery. In this article, we discuss the two different approaches to team-based care, the five core principles, and how to reduce clinician burnout.
Trends and Patterns of Dementia Patient Discharges: SNF vs. Home Health
One-third of all fee-for-service Medicare beneficiaries receiving post-acute care have a diagnosis of dementia, and more than 7 in 10 receive this care in a SNF.
5 Trends and Policies Impacting Social Determinants and Outcomes
The focus on social determinants of health in 2023 is uniting payers and providers to increase their efforts to find solutions and improve outcomes. Driven by policy and payments, change is coming.