Healthcare Compliance Perspective:
Repeated hospital readmissions based upon systemic issues may provide the OIG with the basis to allege false claims and initiate an audit.
Nearly as many hospitals across the country are being penalized by the Centers for Medicare & Medicaid Services (CMS) this year as last year. A total of 2, 573 hospitals will experience cuts in reimbursements by up to 3 percent for 2018. The reason behind these cuts is the concern over patients being hospitalized too soon after being discharged. These penalties have been occurring for nearly six years, and are considered to be contributing to the reduction in the number of repetitive hospital admissions.
The cost of readmissions is just one aspect connected to repeated hospital admissions. There are significant risks associated with readmissions-infection and complications endanger the patient and increase costs.
Hospital readmissions are also a concern for skilled nursing homes, and this is also viewed by CMS as a large problem. Research from 2010 is still being used by CMS regarding this issue. This research indicates that out of every four patients “discharged from an acute care hospital to a skilled nursing facility, one will be readmitted within 30 days.” There are less readmissions when patients are discharged to their homes than when they are discharged to a nursing home.
CMS is approximating that these penalties will result in government savings of about $564 billion.
