CMS incorrectly penalizes hospitals in readmissions program, study finds

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, CMS incorrectly penalizes hospitals in readmissions program, study finds

CMS’ long-standing Hospital Readmission Discount Program incorrectly penalizes hospitals or overlooks hospitals that ought to obtain a penalty, in accordance with a brand new research.

The findings, printed Wednesday in JAMA Cardiology, are the newest to uncover flaws within the Hospital Readmission Discount Program, which has been closely criticized by hospitals and high quality researchers since its inception in 2012 beneath the Reasonably priced Care Act.

The brand new research discovered CMS incorrectly penalizes hospitals resulting from margins of error related to the 30-day risk-adjusted readmission measure this system depends on. The research evaluated three of the six circumstances a part of this system: acute myocardial infarction, pneumonia and coronary heart failure. Utilizing CMS knowledge from 2014 to 2017, the research discovered 20.9% of hospitals ought to have been penalized for his or her readmission charges for acute myocardial infarction however weren’t, whereas 13.5% ought to have acquired a penalty for his or her readmission charge for coronary heart failure and 13.2% for his or her readmission charge for pneumonia. On the identical time, 10.1% of hospitals acquired a penalty for his or her efficiency on readmissions for acute myocardial infarction however should not have, whereas 10.9% had been incorrectly penalized for coronary heart failure and 12.three% for pneumonia.

Within the penalty program, the readmissions charge for hospitals is an estimate as a result of CMS is utilizing a measure with a margin of error. Different outcomes measures CMS makes use of for value-based fee packages even have a margin of error resembling 30-day mortality charges.


Changyu Shen, lead writer of the research and a senior biostatistician on the Smith Middle for Outcomes Analysis in Cardiology on the Beth Israel Deaconess Medical Middle, mentioned he is not conscious of printed analysis till this research that demonstrates how the margin of error really impacts penalties within the readmissions program.

Acute myocardial infarction had the best proportion of fallacious penalties as a result of it had the smallest quantity of discharges within the CMS dataset and subsequently a excessive margin of error. “When you could have the next margin of error, after all you usually tend to make errors,” Shen mentioned.

The findings present the magnitude of incorrectly penalizing hospitals because of the margin of error “just isn’t small,” Shen mentioned.

Researchers ought to now look into how hospitals and affected person outcomes are affected by the wrong penalties, Shen mentioned. “The subsequent step can be to grasp the consequence, does it matter?” he mentioned.

Shen and his colleagues supply some potential options resembling extending the information assortment interval CMS makes use of to lower the margin of error. The authors counsel lengthening the information assortment interval from three years to 12 years for acute myocardial infarction and 6 years for pneumonia and coronary heart failure, though Shen mentioned he acknowledges that point interval is not practical.


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