August 14, 2012

22 CT hospitals hit with Medicare reimbursement penalty

CT Medicare Readmission Penalties

Click here to see how Connecticut hospitals were penalized.

Seventy five percent of Connecticut's 29 acute care hospitals will lose money from the federally funded Medicare program for having high readmission rates, officials say.

The 22 Connecticut hospitals, including Yale-New Haven, Hospital of Central Connecticut, St. Francis, and Waterbury Hospital, are being penalized by the Centers for Medicare and Medicaid Services as part of a new program related to health care reform.

The program, known as the Hospital Readmission Reduction Program (HRRP), penalizes hospitals with higher-than-average readmission rates for certain "applicable conditions," including those related to heart failure and pneumonia.

Readmission occurs when a patient is discharged from a hospital to a non-acute setting, like a nursing home, and then subsequently readmitted to the hospital within 30 days.

During its first year of implementation the HRRP program will penalize hospitals up to 1 percent of their Medicare inpatient payments. That percentage goes up for the next few years until it reaches a cap of 3 percent.

The program aims to force hospitals to reduce health care costs and improve quality by aligning financial incentives with quality outcomes.

In addition to the 22 Connecticut hospitals that are being penalized, Masonic Home and Hospital is also losing the full 1 percent Medicare reimbursement.

Michele Sharp, a spokeswoman for the Connecticut Hospital Association said "hospitals are committed to reducing preventable readmissions," and are working hard to address the issue through several collaborative programs where medical center's share best practices.

Sharp also noted that readmissions result from numerous factors, not all of which are within a hospital's control.

Lack of effective care coordination and/or transitioning care from the hospital to other settings, and lack of adequate access to primary care, pharmacy services, or other resources or services in the community can also lead to patients being forced back into a hospital setting.

"Preventing readmissions is a complex issue that involves hospitals, physicians, and other care providers who manage patient care, as well as patients and their families," Sharp said.

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