Hospitals that perform an index CABG procedure will be penalized for unexpected 30-day readmissions, even if the patient was discharged from a different hospital, according a proposed rule from the Centers for Medicare & Medicaid Services (CMS). CMS intends to add CABG to its readmissions reduction program in 2017.
Under the Reduction to Hospital Payments for Excess Readmissions program, CMS withholds Medicare payments to hospitals with higher than expected 30-day readmission rates for heart failure, acute MI and pneumonia. The penalty initially was set at 1 percent of aggregate payments and will reach 3 percent in 2015.
Based on 2007 recommendations from the Medicare Payment Advisory Commission, Medicare is adding CABG to its list of applicable conditions in fiscal year 2017. CMS developed and submitted a quality measure for CABG that differs from the other conditions in how it doles out penalties.
The proposed CABG 30-day readmission measure includes Medicare beneficiaries who are 65 years old or older who at the time of the index admission had been enrolled in a Medicare fee-for-service program for at least 12 months. CMS reasoned that it needs the full 12 months of data to calculate risk adjustments properly.
The measure excludes patients who are discharged against medical advice, who die during the initial hospitalization or who are not enrolled in a Medicare fee-for-service program for 30 days after discharge. The index CABG admission counts for inclusion and any repeat CABG procedures are excluded.
For heart failure, acute MI and pneumonia, CMS assigns readmission outcomes to the discharging hospital, regardless whether the patient was transferred from another facility. CMS argues that the discharging hospital had the most influence over the risk of readmission.
“[T]ransfer to another acute care facility after CABG is most likely due to a complication of the CABG procedure or the peri-operative care the patient received,” CMS wrote. “Therefore, the care provided by the hospital performing the CABG procedure likely dominates readmission risk, even among transferred patients.”
The final rule was issued April 30 and is scheduled to be published May 15. CMS will accept public comments through June.