CMS has reported that 2,579 hospitals will be affected by downward payment adjustments in 2017 due to penalties associated with the Hospital Readmissions Reduction Program (HRRP). That translates to an average penalty of over $190,000, or a 0.73% reduction in reimbursement value. One of the biggest factors for these downward payment adjustments is avoidable ED readmissions. Over the last five years, healthcare organizations have been reporting on this measure without the weight of downward adjustments. The hope was for hospitals to take advantage of this time to make the necessary strides towards reducing readmissions to acceptable levels, as defined by CMS, for the six conditions taken into consideration: chronic lung disease, coronary artery bypass graft surgery, heart attacks, heart failure, hip and knee replacements, and pneumonia.
Care Coordination a Must for Hospitals Moving Forward
The conditions measured by CMS for reimbursement adjustments require a high level of care coordination once patients are released from the hospital environment. To meet this need, hospitals and integrated care delivery networks will need to work diligently to leverage web-based Health IT technologies and innovative mHealth applications to encourage improved patient adherence to care plans and prescribed medications. These technologies will most likely need to integrate across the full continuum of care. Nonetheless, the need to push healthcare to the primary care setting, focusing on prevention and better disease management, will require providers to implement multi-platform technologies to not only increase patient engagement but better support the clinical decision making and coordination processes.