Some Calif. Hospitals Could Lose Medicare Funds Under CMS Rule
Some California hospitals areÂ at risk of having Medicare payments lowered under a CMS final rule that will slash reimbursements to facilities identified as having high 30-day readmission rates for patients with certain conditions, California Watch reports (Jewett, California Watch, 8/3).
On Monday, CMS issued its inpatient prospective payment system final rule for fiscal year 2012.
The rule outlines a new Hospital Readmissions Reduction Program that will reduce payments to hospitals with "excess readmissions" of myocardial infarction, heart failure and pneumonia patients starting in FY 2013. The final rule also establishes the methodology used to determine excess readmission rates (California Healthline, 8/2).
The rule is designed to reduce costs and boost hospitals' coordination of care for patients after they are discharged.
Federal officials determine where hospitals fall along the national average for readmissions using a complex formula.
According to California Watch, 10 California facilities already have been identified as having high readmission rates for these patients.
Blair Childs -- a vice president at the hospital alliance Premier -- said that hospitals without adequate capital to invest in improving management of former patients ultimately could lose money.
Childs added that many inner-city facilities could be hit hardest under the rule.
California Hospital Actions
UC-San Francisco Medical Center recently undertook an initiative to reduce readmissions.
The facility has reduced 30-day and 90-day readmission rates among elderly heart failure patients by 30%.
According to the Gordon and Betty Moore Foundation, which provided funding for the effort, UCSF has reduced Medicare billing by about $1 million annually and has given patients greater opportunity to remain in their homes.
For additional coverage on the UCSF effort to cut readmission rates, see this previous Capitol Desk post (California Watch, 8/3).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.