This is the last set of readmissions data that won't be affected by the COVID-19 pandemic. CMS normally would have used data from July 2017 to June 2020, but cut off its analysis at December 2019 to exclude the consequences of the pandemic form its review. The agency has not said how will handle readmission data moving forward.
"We are pleased that CMS heard our concerns and excluded data from the first six months of 2020 to account for the pandemic when calculating performance," Demehin said. "We will continue to ask CMS to use its discretion to exclude pandemic-affected data in calculating performance in its hospital quality and value programs going forward."
The readmissions program is now in its fourth iteration of placing hospitals into peer groups based on the percentage of Medicare-Medicaid dual-eligible patients they treat, which is intended to account for social determinants of health that can drive a higher likelihood of people returning to the hospital.
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But the data for the penalties that will be paid this fiscal year show that 80% of hospitals with the highest proportion of dual-eligibles—peer group five—will pay penalties. Meanwhile, almost 72% of hospitals with the lowest number of dualspeer group one—will be assessed penalties. However, hospitals with the high numbers of dual-eligible patients will pay smaller penalties overall.
Stakeholders like the American Hospital Association have suggested taking peer groups even farther by including other social risk factors that are beyond hospitals' control.
"Peer grouping provides relief to many hospitals serving the poorest and most vulnerable communities," Demehin said. "Congress gave CMS the ability to refine its social risk factor adjustment approach over time, and because the research and science on this issue continues to evolve, the AHA has encouraged CMS to consider ongoing refinements."
