Lawmakers want pay that is risk-adjusted

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Rep. Jim Renacci (R-OH)
Rep. Jim Renacci (R-OH)

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

Dual eligibles are at high risk of being readmitted shortly after discharge from a hospital, the letter said. Studies have found that hospitals serving large dual-eligible populations are more likely to have high readmissions rates and subsequently to lose Medicare dollars, the lawmakers wrote.

The Centers for Medicare & Medicaid Services should make changes to the Hospital Readmission Reduction Program to address this, the letter said. Legislation under consideration in the House of Representatives could help. The lawmakers asked CMS “to work with Congress.”

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


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