CMS fines 2,545 hospitals for high readmissions: 5 things to know

In fiscal year 2021, CMS will penalize 2,545 hospitals for having too many Medicare patients readmitted within 30 days, according to federal data cited by Kaiser Health News

This is the ninth year of the Hospital Readmission Reduction Program. To determine penalties for fiscal 2021, CMS examined hospitals’ 30-day readmission rates for patients who had originally been treated for the following conditions: heart failure, heart attack, pneumonia, chronic obstructive pulmonary disease, hip or knee replacement, and coronary artery bypass graft surgery. 

CMS used patient data from July 2016 through June 2019 to determine the penalties. The agency compared each hospital’s reported readmission rate to national averages for each of the conditions to determine the penalties. 

Here are five takeaways from the Nov. 2 Kaiser Health News analysis: 

1. Eighty-three percent of the 3,080 hospitals evaluated received a penalty. 

2. CMS will cut payments to the penalized hospitals by as much as 3 percent for each Medicare case during fiscal 2021, which runs Oct. 1, 2020, through September 2021. 

3. Thirty-nine hospitals were hit with the maximum penalty for fiscal 2021, down from 56 hospitals in fiscal 2020. 

4. The average penalty will be a 0.69 percent payment cut for each Medicare patient. 

5. Of the 3,080 hospitals evaluated, 613 will receive a penalty of 1 percent or more. 

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