Hospitals with the best proportion of sufferers insured by each Medicare and Medicaid had been extra weak this fiscal yr to obtain a penalty in CMS’ readmissions program in comparison with hospitals with the smallest proportion of such sufferers, new information exhibits.
For the third yr in a row, CMS peer grouped hospitals by proportion of twin eligible sufferers to find out penalties in its Hospital Readmissions Discount Program. The change, which handed Congress in 2016, is an try to handle long-standing complaints from safety-net hospitals that they’re unfairly penalized when in comparison with hospitals that see sufferers with much less socioeconomic challenges and dangers corresponding to specialty services. Congress opted to make use of twin eligible standing to point poor socioeconomic standing as a result of the sufferers usually have complicated healthcare wants, have earnings at or under poverty ranges and account for a major proportion of Medicare spending.
However an evaluation by Fashionable Healthcare of the latest information exhibits these in peer group 5 — or hospitals with probably the most proportion of dual-eligible sufferers — had been nonetheless extra more likely to obtain a penalty in fiscal yr 2021 than hospitals in peer group one. Of the 616 hospitals in peer group 5, 499 will see Medicare fee reductions this fiscal yr. By comparability, of the 616 hospitals in peer group one, 448 will obtain a fee discount.
“The aim of the peer grouping method is to create the extent enjoying area throughout hospitals. Might or not it’s higher? Sure, we expect it could possibly be,” mentioned Akin Demehin, the American Hospital Affiliation’s director of coverage. “We knew that utilizing twin eligible standing to arrange the peer teams might have potential limitations.”
High quality researchers and hospital associations have known as the peer grouping of hospitals by twin eligibility a strong first step to determine fairness within the readmissions program, however urge CMS to do extra. For example, AHA advocates for CMS to discover including Census Bureau information corresponding to earnings and zip codes to this system to assist account for socioeconomic standing.
Though hospitals with extra twin eligible sufferers are nonetheless extra more likely to be penalized, they’re hit with smaller penalties than these in peer teams one and two, the information exhibits. This additionally follows tendencies of the final two years.
Of the 1,232 hospitals in peer teams one and two, 24 acquired the utmost three% fee discount to their Medicare funds. By comparability, simply eight of the hospitals in peer teams 4 and 5 acquired the utmost penalty. Additional, 89 hospitals in peer teams one and two acquired a 2% penalty or increased whereas 41 of the hospitals in peer teams 4 and 5 had been hit equally.
Its potential subsequent yr CMS will not be handing out penalties for the readmissions program due to COVID-19. The company instituted extraordinary circumstance exceptions in March, which included excluding readmissions information from the primary two quarters of 2020 within the readmissions program. Then in a September interim remaining rule, CMS mentioned it will consider the information for the rest of 2020 and will decide it might’t reliably be used for penalties. CMS mentioned it might suggest suspending program penalties in consequence by way of proposed rulemaking.