Patient injuries mean Medicare payment penalties for some hospitals

Jun 23 2014

The preliminary analysis of penalties would lower Medicare payments to these hospitals by 1 percent for a year. Elsewhere, lawmakers introduce legislation to change how hospitals that serve a large number of poor patients are affected by Medicare's penalties.

Kaiser Health News: More Than 750 Hospitals Face Medicare Crackdown On Patient Injuries
A quarter of the nation's hospitals -- those with the worst rates -- will lose 1 percent of every Medicare payment for a year starting in October. In April, federal officials released a preliminary analysis of which hospitals would be assessed, identifying 761. When Medicare sets final penalties later this year, that list may change because the government will be looking at performance over a longer period than it used to calculate the draft penalties. Vidant, for instance, says it lowered patient injury rates over the course of 2013, and Handron praises their efforts (Rau, 6/22).

Modern Healthcare: Bill Would Adjust Readmissions For Socio-Economic Factors
A group of U.S senators introduced legislation Thursday that aims to address growing concerns that hospitals serving low-income populations are unfairly penalized under Medicare's Hospital Readmissions Reduction Program. The Hospital Readmission Accuracy and Accountability Act would require the CMS to account for patient socioeconomic status when calculating risk-adjusted readmissions penalties. Holding all other factors constant, socioeconomic conditions-;such as poverty, low levels of literacy, limited English proficiency, minimal social support, poor living conditions and limited community resources-;likely have direct and significant impacts on avoidable hospital readmissions, and adjusting for these factors would improve accountability and quality of care, according to the text of the bill (Rice, 6/20).

And some hospitals say they won't adhere to Medicare's rule on admitting patients to the hospital --

The Journal Gazette: Hospitals Say They Won't Heed '2-Midnight Rule' 
It's called the two-midnight rule, and some hospitals want to avoid it like a measles epidemic. Federal officials want to make sure that hospitals are admitting only those patients who really need extended expert medical care, which is expensive. So they drafted a plan to audit Medicare claims for inpatients whose hospital stays are shorter than two midnights. The theory is that any patient who stays in the hospital longer than that legitimately needs to be there (Slater, 6/22).