Adjust readmission penalties to protect providers serving dual eligibles, lawmakers urge CMS

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The calculation method for Medicare readmissions penalties should be risk-adjusted so that providers do not lose money for serving the sickest, poorest seniors, a bipartisan group of Congressional lawmakers said in a recent letter to regulators. Long-term care providers are carefully monitoring how hospital readmissions penalties are calculated, because nursing home reimbursements will be tied to readmissions starting in 2018.

Seniors eligible both for Medicare and Medicaid often have complex health conditions and lack resources, so they are at high risk of being readmitted shortly after discharge from a hospital, the letter notes. Studies already have found that hospitals serving large dual-eligible populations are much more likely to have high readmissions rates and to lose Medicare dollars because of that, the lawmakers wrote.

The Centers for Medicare & Medicaid Services should make changes to the Hospital Readmission Reduction Program to address this issue, the legislators wrote. There is legislation under consideration in the House of Representatives that would make some of these changes, and the lawmakers asked CMS “to work with Congress” on this matter.

Rep. Jim Renacci (R-OH) spearheaded the June 10 letter, and he was joined by 33 other signatories.

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