Because CMS didn’t make significant changes to the measures or penalty calculation formulas, it is no surprise the latest round of penalties are comparable to fiscal 2024, said Akin Demehin, senior director for quality and patient safety policy at the American Hospital Association.
Nevertheless, Demehin said it is impressive that readmissions rates and penalties have not worsened, given the fact that the data is from after the start of the pandemic.
“Hospitals have continued to proactively identify risks for readmissions and try to mitigate them,” he said. “They've worked very closely with their post-acute care partners to provide the right kinds of discharge instructions and care coordination to try to reduce that risk.”
For the upcoming year, 7% of hospitals will be charged penalties of 1% or more, compared with 7.5% last year.
Meanwhile, 71.6% of hospitals will be charged penalties of less than 1% on their readmissions. That compares with 70.1% of hospitals in fiscal 2024.
Another 21.4% of hospitals will not be assessed penalties. A year ago, 22.4% of hospitals received no penalty.
The average readmission penalty for hospitals with the highest proportion of Medicare-Medicaid dual-eligible patients is 0.31%. For hospitals with the lowest number of dual-eligible patients, the average penalty is 0.32%. During fiscal year 2024, those two groups were assessed penalties of 0.29% and 0.34%, respectively.
CMS will release the final data Oct. 1.
Next year, it is likely that hospitals will see some improvement in penalties as elective procedure volumes rebound and there is more data available on how facilities are reducing readmissions following those procedures, Demehin said.
Also, as health systems explore the use of artificial intelligence and predictive technologies to identify potential risks to patients — including risks that could contribute to readmissions — the efforts may also affect hospital performance, he said.
