New, tougher Medicare readmission penalties take effect Oct. 1

Hospitals face new financial penalties this week if they fail to prevent avoidable readmissions among Medicare patients.

Since October 2012, hospitals have been penalized when heart attack, heart failure and pneumonia patients return to the hospital within 30 days. Starting Wednesday, that fine goes up to 3%, from the 1% penalty incurred when the program started. In addition, unplanned readmissions for patients who received a total hip or knee replacement or have chronic obstructive pulmonary disease will trigger penalties for the first time. The readmission penalties have been credited with helping keep Medicare cost growth at historic lows.

“More hospitals are getting penalized and more hospitals are getting bigger penalties,” said Hiten Patel, managing director at The Advisory Board Company.

There is little published research on what hospitals and physicians can do to prevent readmissions for COPD patients, said Dr. Anne Dixon, director of pulmonary and critical-care medicine at Fletcher Allen Health Care in Burlington, Vt.

To prevent such readmissions, Fletcher Allen is developing a pathway to treat COPD patients, who make up about 8% of the system's adult patients. The system's electronic health records have been modified to remind clinicians that COPD patients should get flu shots and participate in smoking-cessation programs.

Still, some experts say hospitals fare better in preventing readmissions when they focus on improving patient care overall rather than targeting specific conditions, and when they strive to make immediate post-discharge procedures safer.

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