Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals
The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.
Teaching, Rural Hospitals Gain From CMS Readmission Changes
The CMS' Hospital Readmissions Reduction Program hit academic and rural hospitals with lower penalties in 2019 compared to 2018, after the agency made changes to the program, according to a new study. The research, published Monday in JAMA Internal Medicine, found 44.1% of teaching hospitals and 43.7% of rural hospitals experienced a lower penalty in 2019 compared to 2018 from the readmissions program. The smaller penalties were the result of changes made to the readmissions program this year in which hospitals were separated into five groups by similar proportion of patients who are dually eligible for Medicare and Medicaid. (Castellucci, 4/15)
New Beneficiaries Are Leading To Financial Woes For Hospital ACOs
Hospital-led ACOs may be struggling financially as sicker beneficiaries switch to their care from physician-led ACOs, according to a new analysis. As Medicare beneficiaries develop more complex diseases, they are more likely to switch from a physician to a hospital-led ACO, according to researchers with the University of Wisconsin Health. That can lead to higher costs for hospital ACOs, which are already under fire from the CMS for not producing similar savings as their physician counterparts. (King, 4/15)
Primary Care Accounts For Tiny Share Of Medicare Spending
Only about 2% of total Medicare spending is dedicated to primary care under a narrow definition of the term, a ratio that RAND Corp. researchers found surprisingly low in their analysis. The researchers used both narrow and broad definitions of primary care in their study, published in JAMA Internal Medicine on Monday. Broad primary care made up 4.88% of Medicare spending, compared with 2.12% under the narrow definition. By comparison, primary-care spending averages 7.7% across commercial PPO plans, a 2017 Milbank Memorial Fund study found. (Bannow, 4/15)