CMS to punish more than 2.5k hospitals for 30-day readmissions: 7 things to know

Despite the political tumult over a potential ACA repeal, CMS is set to enforce the health law's readmission rule by penalizing 2,573 hospitals for having too many Medicare patients readmitted within 30 days, according to federal data released Wednesday cited in a Kaiser Health News report.   

Here are seven key takeaways from the KHN report.

1. Beginning in October, CMS will cut payments to the penalized hospitals by as much as 3 percent for a year for having high rates of 30-day readmissions for heart attack, heart failure and pneumonia.

2. Last year, CMS penalized all but 174 of the same hospitals for readmissions.

3. The penalties are estimated to result in $564 million in savings for the federal government, which is comparable to the amount saved last year under the ACA's readmission rule.

4. The rule, established in 2012, sought to address  the high readmissions rates among Medicare beneficiaries and address the high rates of medical costs associated with these readmissions.

5. Since the rule's implementation, America witnessed a reduction in repeat hospital patients. Between 2007 and 2015, readmissions for conditions addressed by the rule for Medicare patients dropped from 21.5 percent to 17.8 percent.

6. However, the rate of reduction in readmissions leveled off in recent years, suggesting a plateau in the level of improvements possible under the rule.

"We have indeed reached the limits of what changes in how we deliver care will allow us to do," Nancy Foster, vice president for quality at the American Hospital Association, told KHN. "We can't prevent every readmission. It could be that there is further room for improvement, but we just don't know what the technique is to make that happen."

7. Some experts suggest the political acrimony over a potential ACA repeal stalled talks on how to improve the nation's current health system.

"We've spent the last six months fighting about how we're going to pay for health insurance, which is one part of the ACA," Ashish Jha, MD, a professor at the Harvard T.H. Chan School of Public Health in Boston, told KHN. "There's been almost no discussion of the underlying healthcare delivery system changes that the ACA ushered in, and that is more important in the long run to be discussing because that's what's going to determine the underlying costs and outcomes of the health system."

To read the full Kaiser Health News report, click here.

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