The Affordable Care Act of 2010 established the Hospital Readmissions Reduction Program that requires CMS to reduce payments to hospitals with excess readmissions within 30 days beginning in 2012. Excess readmissions are defined as being compared to the national average for that set of patients with applicable condition. Factors such as demographic characteristics, comorbidities and patient frailty were all taken into consideration. Initially it included those patients with acute myocardial infarction, heart failure and pneumonia. COPD and elective total hip arthroplasty and total knee arthroplasty are being added for 2015. Penalties for excessive readmissions were incrementally increased annually and can range from 1% to 3%. These penalties apply to all payments received from CMS and thus are a substantial amount.
CMS felt that the national average of Medicare readmissions was too high and reflective of the quality of care these patients received, therefore instituted the readmission reduction program as a way to improve the quality of transitional care, ensuring coordination of care into the community at a safe, lower level of care. Therefore, readmissions is considered an important quality indicator of care in the hospital.
A protocol was launched as a response to these CMS concerns. From the inception of this program Fairview park Hospital has not received a penalty from CMS for exceeding the readmission goal.
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