Enhancing Medicare’s Hospital-Acquired Conditions Policy to Encompass Readmissions

McNair, Peter; Luft, Harold S.

doi:10.5600/mmrr.002.02.a03

Cited by 11 publications

(9 citation statements)

References 9 publications

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“…Timing may play a role in the risk of double penalties. McNair and Luft pointed out that conditions penalized under the HACRP may not manifest themselves until a readmission occurs 34 . In the study by Raines et al, nearly half (47%) of hospital-acquired conditions were not identified until after discharge from the index admission.…”

Section: Discussionmentioning

confidence: 99%

Reimbursement Penalties and 30-Day Readmissions Following Total Joint Arthroplasty

et al. 2020

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Background: The U.S. Patient Protection and Affordable Care Act created the Hospital Readmissions Reduction Program (HRRP) and the Hospital-Acquired Condition Reduction Program (HACRP). Under these programs, hospitals face reimbursement reductions for having high rates of readmission and hospital-acquired conditions. This study investigated whether readmission following total joint arthroplasty (TJA) under the HRRP was associated with reimbursement penalties under the HACRP. Methods: Hospital-level data on hospital-acquired conditions, readmissions, and financial penalties were obtained from Definitive Healthcare. Outcomes included receipt of an HACRP penalty and the associated losses in revenue in 2018. Logistic regression and linear regression models were used to determine whether the all-cause, 30-day readmission rate following TJA was associated with the receipt or magnitude of an HACRP penalty. Results: Among 2,135 private, acute care hospitals, 477 (22.3%) received an HACRP penalty. After controlling for other patient and hospital characteristics, hospitals with a 30-day readmission rate of >3% after TJA had over twice the odds of receiving an HACRP penalty (odds ratio, 2.20; p = 0.043). In addition, hospitals with a readmission rate of >3% after TJA incurred $77,519 more in revenue losses due to HACRP penalties (p = 0.011). These effects were magnified in higher-volume hospitals. Conclusions: Acute care hospitals in the United States with higher 30-day readmission rates following TJA are more likely to be penalized and to have greater revenue losses under the HACRP than hospitals with lower readmission rates after TJA. This strengthens the incentive to invest in the prevention of readmissions after TJA, for example, through greater efforts to reduce surgical site infections and other modifiable risk factors.

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Section: Discussionmentioning

confidence: 99%

Reimbursement Penalties and 30-Day Readmissions Following Total Joint Arthroplasty

et al. 2020

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“…15 Further, a potentially preventable 30-day readmission was defined as any readmission from any cause which potentially could have been prevented by an intervention during the index hospitalization as agreed upon by two study neurologists (Manoj Mittal and Alejandro Rabinstein). A third neurologist (Kelly Flemming) was available for any disagreement.…”

Section: Methodsmentioning

confidence: 99%

A population-based study for 30-d hospital readmissions after acute ischemic stroke

Mittal

Rabinstein

Mandrekar

et al. 2016

International Journal of Neuroscience

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Objective To determine post-stroke 30-day readmission rate, its predictors, its impact on mortality, and to identify potentially preventable causes of post-stroke 30-day readmission in a population-based study. Patients and Methods We identified all acute ischemic strokes (AIS) using the ICD-9 codes (433.x1, 434.xx, and 436) via the Rochester Epidemiology Project (REP) between January 2007 and December 2011. Acute stroke care in Olmsted County is provided by two medical centers, Saint Marys Hospital (SMH), and Olmsted Medical Center Hospital (OMCH). All readmissions to these two hospitals were accounted for this study. Thirty-day readmission data was abstracted through manual chart review. The REP linkage database was used to identify the status (living/dead) of all patients at last follow up. Results Forty one (7.6%, 95% CI 5.7%-10.2%) of total 537 AIS patients were readmitted 30 days post-stroke. In a multivariable logistic regression model, discharge to nursing home following index stroke (OR: 0.29, 95% CI 0.08-0.84) was an independent negative predictor of unplanned 30-day readmission. In a subgroup of patients with dementia, being married at time of index stroke was found to be a negative predictor of readmission (OR 0.10, 95% CI 0.005-0.58). Only 2.8% of the patients had potentially preventable readmissions. Hospital readmission had no significant impact on patient's short (3 months) or long term (1 or 2 years) mortality (p>0.05). Conclusion Post-stroke 30-days readmission rate is low in AIS patients from Olmsted County. Further research is needed in regarding discharge checklists, protocols, and stroke transitional programs to reduce potentially preventable readmissions.

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“…Furthermore, most SSIs occur after discharge but within 30 days after surgery and would not be identified in the index admission 27 28 Under the CMS nonpayment policy, which targets only index admissions, most of orthopedic SSIs would not be penalized 13 . However, in our sensitivity analyses, which included SSI that occurred within 30 days postdischarge, results were similar to our main analyses that demonstrated significantly reduced rates for both Medicare patients and the control group following the CMS nonpayment policy, yet the policy itself was not associated with reduced rates of SSI in the targeted population compared to the unaffected control group.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Other estimates have cited $565 million additional costs to hospitals annually due to HACs targeted by CMS, with most of the added cost attributable to orthopedic infections. 13 To date, the effect of the CMS nonpayment penalty on patient outcomes has remained unclear.…”

mentioning

confidence: 99%

“…– 9 Taken together, the estimated annual cost to Medicare for SSIs following these orthopedic procedures is approximately $3.5 million, 10 and they cost up to 3.8 times more than an uncomplicated procedure 11 12 Other estimates have cited $565 million additional costs to hospitals annually due to HACs targeted by CMS, with most of the added cost attributable to orthopedic infections 13 . To date, the effect of the CMS nonpayment penalty on patient outcomes has remained unclear.…”

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confidence: 99%

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Effect of Medicare’s Nonpayment Policy on Surgical Site Infections Following Orthopedic Procedures

Kwong

Weng

Finnegan

et al. 2017

Infect. Control Hosp. Epidemiol.

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OBJECTIVE Orthopedic procedures are an important focus in efforts to reduce surgical site infections (SSIs). In 2008, the Centers for Medicare and Medicaid (CMS) stopped reimbursements for additional charges associated with serious hospital-acquired conditions, including SSI following certain orthopedic procedures. We aimed to evaluate the CMS policy's effect on rates of targeted orthopedic SSIs among the Medicare population. DESIGN We examined SSI rates following orthopedic procedures among the Medicare population before and after policy implementation compared to a similarly aged control group. Using the Nationwide Inpatient Sample database for 2000-2013, we estimated rate ratios (RRs) of orthopedic SSIs among Medicare and non-Medicare patients using a difference-in-differences approach. RESULTS Following policy implementation, SSIs significantly decreased among both the Medicare and non-Medicare populations (RR, 0.7; 95% confidence interval [CI], 0.6-0.8) and RR, 0.8l; 95% CI, 0.7-0.9), respectively. However, the estimated decrease among the Medicare population was not significantly greater than the decrease among the control population (RR, 0.9; 95% CI, 0.8-1.1). CONCLUSIONS While SSI rates decreased significantly following the implementation of the CMS nonpayment policy, this trend was not associated with policy intervention but rather larger secular trends that likely contributed to decreasing SSI rates over time. Infect Control Hosp Epidemiol 2017;38:817-822.

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Enhancing Medicare’s Hospital-Acquired Conditions Policy to Encompass Readmissions

Cited by 11 publications

References 9 publications

Reimbursement Penalties and 30-Day Readmissions Following Total Joint Arthroplasty

Reimbursement Penalties and 30-Day Readmissions Following Total Joint Arthroplasty

A population-based study for 30-d hospital readmissions after acute ischemic stroke

Effect of Medicare’s Nonpayment Policy on Surgical Site Infections Following Orthopedic Procedures

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