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Chronic Lung Disease Readmission Penalties Hurt Safety-Net Hospitals

ANN ARBOR, MI – Hospitals that care for poor and minority patients will be disproportionately affected by fines the CMS assesses for too many readmissions for chronic lung disease, according to a new study.

The analysis by University of Michigan researchers was published recently in The American Journal of Respiratory and Critical Care Medicine.

"We worry that this policy may cause more harm than good," said author Michael Sjoding, MD, a pulmonary and critical care fellow in the U-M Medical School's Department of Internal Medicine. "Medicare is trying to improve patient care and reduce waste, but the hospitals they are penalizing may be the ones who need the most help to do so."

Fines for excessive readmissions are at an all-time high, with more than 2,600 hospitals being hit, according to Kaiser Health News’ recent analysis of federal records. One reason is that Medicare is evaluating readmissions of two new categories of patients: those admitted for elective knee or hip replacements, and those suffering from chronic lung disease such as chronic bronchitis and chronic obstructive pulmonary disease (COPD). For the past two years, readmissions above Medicare’s expectations have been penalized for heart failure, heart attack and pneumonia patients.

About 400 more hospitals than last year are facing penalties, according to the KHN analysis, which also noted that half of the hospitals in 29 states and the District of Columbia will be affected. In addition, the ceiling for fines increased this year to 3% of reimbursements.

For the University of Michigan study, researchers evaluated three years of data on 3,018 hospitals that cared for patients with COPD. Based on past admission rates, they discovered that teaching hospitals and safety-net hospitals will bear the brunt of the new financial penalties.

Poor or medically complex patients with COPD are at a higher risk for readmissions because of a large number of socioeconomic and health factors, according to the study.

While the Hospital Readmission Reduction Program was designed to motivate hospitals to improve the quality of care for select diagnoses by providing financial incentives to lower readmissions, study authors emphasize that patients often get readmitted for reasons outside a hospital's control.

"If patients can't afford medications, or have unstable housing situation, they may end up being readmitted to the hospital," Sjoding pointed out. "No interventions to date have effectively and sustainably reduced COPD readmissions, so it's unclear what a hospital can do to prevent them."

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