The federal government has eased annual penalties for hospitals with higher-than-expected relapse rates due to acknowledging the volatility the COVID-19 pandemic has caused, resulting in mild penalties. highest since 2014.
The Hospital Index Reduction Program has been a mainstay of Medicare’s hospital billing system since its inception in 2012. Created by the Affordable Care Act, the frequency review program Medicare patients at most hospitals return within 30 days and reduce future payments to hospitals with larger-than-expected rates of return. Hospitals can lose up to 3% of each Medicare payment in a year.
The pandemic has plunged hospitals into chaos, flooding them with COVID patients while forcing many to postpone elective surgeries for months. As the Centers for Medicare & Medicaid Services assessed hospital readiness for the previous three years as usual, the government decided to exclude the first half of 2020 because of the turmoil caused by the pandemic. . CMS also excluded from its calculations Medicare patients who had been cured of pneumonia for all three years because it was difficult to distinguish them from patients with COVID.
Akin Demehin, senior director of quality and patient safety policy at the American Hospital Association, said the changes were warranted. “The COVID pandemic has done a lot of unprecedented things for hospital care models,” he said.
After making those changes, CMS assessed 2-and-a-half-year cures for Medicare patients who had experienced heart failure, heart attack, chronic obstructive pulmonary disease, coronary artery bypass grafting, and knee replacement, and hip. As a result of its analysis, CMS has fined 2,273 hospitals, the least since the financial year ended September 2014, a KHN analysis showed.
The average payment reduction was 0.43%, also the lowest since 2014. The reduction will be applied to each Medicare payment to affected hospitals between October 1 and September. and cost them $320 million in that 12-month period.
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Some hospitals will see their penalties drop significantly from last year. Penalties for St. Mary in Athens, Georgia, is falling from 2.54% to 0.06%. Saint Joseph East of Lexington, Kentucky, was fined the maximum, 3%, last year; it will lose 0.78% as of October 1. In Flemington, New Jersey, the penalty for Hunterdon Medical Center dropped from 2.29% to 0.12%.
To limit penalties, many hospitals in recent years have instituted new strategies to keep old patients from needing follow-up visits. Dr Robert Coates, interim medical director of Hunterdon Health, which owns Hunterdon Medical Center, said in a statement that the hospital had set up a system to identify patients who visited the emergency room. within 30 days of hospital stay. Instead of reading ahead, Hunterdon helps them schedule next-day appointments at the doctor’s office or monitor their health at home. Hunterdon also calls all discharged patients to ensure they have filled their prescriptions and return to their clinician within one week of discharge.
Dr. Jessica Satterfield, director of quality and clinical excellence for the St. their medication was correct and they re-examined. “We are proud that our efforts are bearing fruit in the form of significant reductions in penalties, but more importantly, as a reflection of the exceptional care staff and staff take,” says Satterfield. our medical staff for patients.
Saint Joseph East did not respond to emails seeking comment.
Despite the changes, 43% of the 5,236 hospitals nationwide were fined. Of the unallocated numbers, all but 770 were automatically exempted. The 2,193 exempt hospitals include those that specialize in children, the mentally ill or veterans. Rehabilitation and long-term care hospitals are also excluded from the program, as are critical access hospitals, which Medicare pays differently to help them stay open in areas where no other hospitals are available. . The government also exempts hospitals in Maryland because that state has a special payment agreement with Medicare. Of the hospitals that Medicare reviews, 75% are penalized.
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For the fiscal year that begins this month, Medicare also cites the pandemic in giving hospitals the payoff from their other key quality-focused effort to assess penalties: the Rebate Program. Hospital Condition. It cuts Medicare payments by 1% for a quarter of general hospitals with the highest rates of infections and other preventable patient injuries. In the previous fiscal year, CMS penalized 764 hospitals under that program. Those penalties — which will cost hospitals about $350 million this year — will continue next fiscal year, with adjustments more tailored to COVID patients. CMS will also refine the readback penalty program to distinguish pneumonia patients from COVID patients.
“COVID has been an incredibly disruptive driver of all aspects of healthcare, most certainly CMS’s quality measurement programs,” said Demehin. “It’s probably going to be a tumultuous couple of years for misread penalties.”
Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
