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Posted On October 09, 2019

Why Are Hospitals in Indiana Under the Gun?

Hospitals across Indiana are facing penalties for high patient readmission rates. The number of patients who return for care after discharge can speak volumes about a hospital’s quality of care. For example, high rates of readmission could signal that a medical facility failed to provide adequate treatment or care during the patient’s first admission.

CMS Penalizing Hospitals Across the State

According to an Indianapolis Business Journal report published in October 2019, the Centers for Medicare and Medicaid Services will be penalizing over 80% of Indiana’s hospitals for poor performance. The penalties, enacted through CMS’ hospital readmissions reduction program, are based on the rate of patient readmissions. Nationally, Indiana ranks 29th for the percentage of penalized hospitals.

As a result of high numbers of patient return visits, CMS is docking the Medicare reimbursements for 60 hospitals in Indiana. For the fiscal year 2020, fines will total approximately $10.2 million.

The Hospital Readmissions Reduction Program

The Hospital Readmissions Reduction Program, or HRRP, is a value-based purchasing program developed through the Affordable Care Act. The HRRP reduces Medicare reimbursements to hospitals with excess numbers of patients who return for care within one month of discharge.

For the fiscal year 2020, the HRRP bases reimbursement penalties on the rate of patients with certain principal diagnoses who were readmitted within 30 days of their initial discharges between July 1, 2015, and June 30, 2018. The applicable diagnoses include, but are not limited to, acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, heart failure, coronary artery bypass graft surgery, and total hip or total knee arthroplasty. The readmission rate includes unplanned readmittances and returns to the same hospitals or other acute care hospitals for any reason.

Improving Quality of Care

The HRRP incentivizes hospitals to go above and beyond with their care by linking payment for services to the quality of care patients receive. The program’s aim is to improve healthcare for Americans while reducing the burden on taxpayers for treatments that should have been addressed during patients’ first visits or might have been avoided with adequate follow up. To help improve their numbers, hospitals have taken steps, including, but not limited to, increasing the involvement of patients and their caregivers in post-discharge planning and placing an emphasis on communication and care coordination.

Hospital errors and inadequate care account for nearly 40% of readmissions. When medical mistakes or negligence cause patients to suffer injuries or their medical conditions to worsen, victims can file a lawsuit to hold the hospital accountable.

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