Medicare Penalty for COPD Readmissions May Penalize
Michigan U. study hypothesizes teaching hospitals may
get most penalties for treating poor and worst cases
2, 1024 - Last month, the federal government revealed that it will fine
more than 2,600 hospitals in the coming year, because too many Medicare
patients treated at these hospitals are ending up back in the hospital
within 30 days of going home. Two new conditions have been added in this
round of penalties: elective hip and knee replacement and chronic lung
Now, a new University of Michigan analysis funded
by the National Institutes of Health and the Agency for Healthcare
Research and Quality suggests that penalties for chronic lung disease
will have a greater impact on hospitals that care for poor and minority
patients. The findings are published in The American Journal of
Respiratory and Critical Care Medicine.
We hypothesized that hospitals caring for a high
percentage of patients of low SES and teaching hospitals would be those
most likely penalized for high COPD readmission rates under the HRRP,
the authors write in the The American Journal of Respiratory and
Critical Care Medicine.
Approximately one in five Medicare patients are
rehospitalized within 30 days of discharge, a rate the Centers for
Medicare & Medicaid Services (CMS) considers excessive.
Since 2012, CMS has reduced payments to hospitals
with excessive readmission rates for patients with heart failure, heart
attack, or pneumonia.
Now, CMS is also including readmissions for
hip/knee replacement surgery and chronic obstructive pulmonary disease
also known as COPD in their calculations of a hospital's penalties.
"We worry that this policy may cause more harm then
good," says author Michael Sjoding, M.D., a pulmonary and critical care
fellow in the U-M Medical School's Department of Internal Medicine.
"Medicare is trying to improve patient care and
reduce waste, but the hospitals they are penalizing may be the ones who
need the most help to do so."
For the study, researchers evaluated three years of
data on 3,018 hospitals that cared for patients with COPD. They found
that, based on readmission rates in the past, teaching hospitals and
safety-net hospitals will bear the brunt of the new financial penalties.
These hospitals often care for a larger number of
poor or medically complex patients with COPD who are at a higher risk
for readmissions because of a large number of socioeconomic and health
CMS's Hospital Readmission Reduction Program was
designed to stimulate hospitals to improve the quality of care for
select diagnoses by providing financial incentives to lower
readmissions. But research shows many times patients get readmitted for
reasons outside a hospital's control.
"If patients can't afford medications, or have
unstable housing situation, they may end up being readmitted to the
hospital," says Sjoding.
"No interventions to date have effectively and
sustainably reduced COPD readmissions, so it's unclear what a hospital
can do to prevent them."
Prior studies found penalties for other conditions
may also target hospitals caring for vulnerable patients. Experts have
recommended that the policy should be changed, but whether Medicare will
make any changes to address the issue is not clear.
In addition to Sjoding, the study was co-authored
by Colin Cooke, M.D., M.S., M.Sc., an assistant professor of internal
medicine and member of the Institute for Healthcare Policy and
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