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Written by: Vester Gravley on Thursday, August 20, 2015 Posted in:

For several weeks now I have been mulling over one of the biggest changes destined to redefine healthcare in the 21st century: the new CMS reimbursement guidelines (expectations?/imperatives?) regarding readmission reduction. If this is the first you have heard about it you are already behind the eight ball. Starting with data from last year (FY2010) collected on patients with AMI, CHF and Pneumonia, the Center for Medicare and Medicaid Services will begin to decrease ALL Medicare reimbursements for acute care facilities based on readmission levels of these DRG’s (re-admissions up/reimbursements down). Conversely, there are financial incentives for those hospitals that can show a reduction of readmission rates. Starting in 2015 COPD readmissions will also become part of the mix. At first blush this appears to place hospitals in the fascinating position of an industry whose best way to make money is to find ways to not do what it was intended to do, namely treat patients. And indeed, at a high level, this is the case. For years the goal has been to decrease length of stay, to get the patients well enough to leave the hospital, and then move them out as quickly as possible! Now, not only does the patient need to be discharged within a certain time frame, but they must be well enough to not return anytime soon. At least that’s a small piece of the overall strategy of the new industry of wellness. This is a game changer! More on that next time.

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