There are new rules and regulations on Hospital Readmissions that will now push Hospitals and Nursing facilities to work side by side to avoid penalties and loss of profit from CMS’ (Center for Medicare and Medicaid Service)
One out of every five Medicare beneficiaries discharged from the hospital is readmitted within 30 days, which costs Medicare more than $17 billion a year, CMS is about to put a stop (Readmissions Reduction Program) to this. Readmissions are an issue between nursing facilities and Hospitals. If a Medicare patient discharged from a hospital, the odds are about 1 in 5 that they will end up back in the hospital within 30 days. CMS is stepping in because Healthcare costs are rising and CMS is going to start by holding hospitals and nursing facilities accountable for readmissions.
The Hospital Readmission Reduction Program (Affordable Care Act) From Oct 2011- Oct 2012, CMS is tracking each hospital’s readmission rate. In order to calculate this rate, they are looking at Medicare Fee-for-Service residents that are discharged from the hospital and whether or not they are readmitted within 30 days. The Diagnosis that CMS is Currently tracking on any resident from a nursing facility that is discharged from the hospital with: Heart Failure, Pneumonia, and Acute Myocardial Infarction (Heart Attack), COPD will be the next tracked diagnosis. If a resident is discharged from the hospital with a tracked diagnosis, and goes back to the hospital within 30 days for any reason, excluding planned or elective procedures, that counts as a readmission. If a resident is discharged from the hospital with Heart Failure, Pneumonia, Acute Myocardial Infarction (Heart Attack) And goes back to the hospital for ANY reason within 30 days, that increases the hospital’s readmission rate and will give them a payment penalty. (Readmissions Reduction Program)
In October 2012, if a hospital’s readmission rate is higher than CMS’ expected readmission rate, that...