Oops: CMS revises HF, acute MI readmissions penalties

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 - warning, stop, caution

The Centers for Medicare & Medicaid Services (CMS) revised penalties under its hospital readmissions reduction program, which kicked in Oct. 1. CMS said it was correcting technical errors that appeared in the final rule on Aug. 31 in the Federal Register.

“We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems,” CMS wrote. The agency added that some changes are related to provisions of the Patient Protection and Affordable Care Act (PPACA), which gave Medicare authority to penalize hospitals with higher-than-expected unplanned readmissions for heart failure (HF), acute MI and pneumonia.

CMS reported that it “inadvertently included Medicare inpatient claims from the FY 2008 MedPAR file with discharge dates occurring prior to July 1, 2008, in determining the base operating DRG payment amounts in the calculation of aggregate payments for excess readmissions and aggregate payments for all discharges that were used to calculate the readmissions adjustment factors.”

In its notice, CMS said the changes apply to discharges that occur on or after Oct. 1. Under the hospital readmissions reduction program, Medicare can withhold up to 1 percent in payment to poor performers in fiscal year 2013, increasing to 2 percent in 2014 and 3 percent in 2015. In 2015, the program expands to include chronic pulmonary obstructive disease, CABG, PCI and other vascular conditions.   

The October issue of
Cardiovascular Business reviews programs that aim to improve outcomes and lower HF and MI readmissions rates. To learn more, go here