Publication: Healthcare Financial Management
Date published:
Language: English
PMID: 17804
ISSN: 07350732
Journal code: HFM

HFMA has recommended changes to a plan pro - posed by the Centers for Medicare & Medicaid Services (CMS) to implement a hospital readmissions reduction program. In its letter to CMS, HFMA says the agency should take steps to provide hospitals with readmissions data, align financial incentives across the care continuum, and change how excessive readmissions are defined and calculated.

In the letter, HFMA urges CMS to provide hospitals with all patient level Medicare A, B, and D claims data on a monthly basis for readmitted patients. HFMA also recommends the acceleration of the value -based payment adjustment for physicians and skilled nursing facilities to better align incentives.

In recommending to change the definitions and calculations of excessive readmissions, HFMA says there are insufficient exclusions for readmissions not related to the index admission, the risk adjustment mechanism does not account for socioeconomic factors, and the minimum number of conditions required for participation is insufficient to offer statistical reliability. HFMA also ree - ommends that CMS develop modifiers to identify and exclude planned readmissions and readmissions related to random occurrences from the hospital-specific readmissions count.

Without HFMA's recommended changes, the final rule would result in hospitals being "inappropriately penalized for circumstances beyond their control," the letter says. "HFMA believes that inappropriately penalized hospitals could be irreparably harmed, jeopardizing care not only for Medicare beneficiaries but for the entire community served by these providers."

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