You’ll get penalized up to 1% of your hospital’s Medicare reimbursement if your readmission rates for acute heart failure (AHF), myocardial infarction (MI) and pneumonia are above national averages. But how can you be sure the rates that CMS is sending you are really accurate?
You can’t, according to the American Hospital Association.
CMS is supposed to eliminate planned readmissions as well as the readmissions for incidents unrelated to the big three measures from their calculations, Nancy Foster, vice president of quality and patient safety policy with AHA, tells us.
But even though Congress mandated the organization to exclude these factors from their calculation, she says, they have yet to do so.
This means you could be getting penalized for readmissions that should not be showing up in the first place. AHA released a guide last year breaking down the different types of readmissions and how they affect your numbers.
“We’ve been pushing CMS very hard to take the steps mandated by Congress,” says Foster. “However, CMS has made a judgment that they are not going to do anything to eliminate planned or unrelated readmissions from their calculations at this time."