Ask the nursing expert ... about Medicare penalties

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Angel McGarrity-Davis, RN, CDONA, NHA
Angel McGarrity-Davis, RN, CDONA, NHA

I'm hearing a lot about Medicare penalties. Should I be worried about this?

Yes, it's important to understand. The government wants to reduce the number of patients being readmitted to hospitals, which means skilled care partners inevitably are getting pressure to perform better.

Most recently, 2,610 hospitals will have Medicare payments reduced, and they'll lose about $428 million. The overall number of penalized hospitals went up compared to October 2012-2013, and the overall penalty value was much higher. 

It's going to get tougher: new diagnoses, such as COPD, and elective surgeries for hips and knees will be added to the mix, and hospitals' penalties could become as much as 3%. 

Not only that, but in a couple of years, skilled nursing facilities also will be subject to losses in reimbursement for hospital readmission rates that are too high.

The good news is that we can be the game-changers in the whole broken healthcare system today. 

For instance, we should have reimbursement for the clinical/rehabilitation programs we use that have proven, evidence-based outcomes that keep patients out of the hospital. We should be recognized for preventing the exacerbation of problems by focusing on and using the necessary follow-up on preventive wellness, medication compliance and disease management. 

We do these things for better healthcare, reduction of costs, and because it is the RIGHT thing for patients and their quality of life.  If we do not act, the changes will go on without us.

Now is the time to tighten up processes and improve quality programs. The payoff — and lack of payment penalties — will soon be very obvious.