Senators Offer Bill To Ease Readmission Penalties On Some Hospitals

A bipartisan group of senators introduced legislation on Thursday to make Medicare take the financial status of hospital patients into account when deciding whether to punish a hospital for too many readmissions.

The bill attempts to address one of the main complaints about the readmissions program: that hospitals serving large numbers of low-income patients are more likely be penalized. Over the past two years, the federal government has reduced payments to two-thirds of the nation’s hospitals because they have high numbers of patients becoming ill and returning after being discharged. This fall the program will put as much as 3 percent of a hospital’s Medicare payments at risk and it will expand the number of conditions it bases the assessment on — currently heart attack, heart failure or pneumonia – to include chronic obstructive pulmonary disease and total hip and knee replacement.

Medicare does adjust for different levels of sickness of patients among hospitals, but it has said the Affordable Care Act, which created the program, does not give regulators the leeway to take socio-economic status into account.

An advisory committee to Congress last year recommended that lawmakers change the program.  The idea of taking socio-economic status into account has also been endorsed in a draft report from  a panel created by the National Quality Forum, which is a nonprofit group that reviews quality measures for the government.

The bill is sponsored by Democratic Sens. Joe Manchin of West Virginia and Bill Nelson of Florida. The Republican sponsors are Sens. Roger Wicker of Mississippi and Mark Kirk of Illinois. The bill does not specify how to revise the penalty program, leaving that up to Medicare.

“This recognizes there are hospitals that maybe are providing excellent care that isn’t reflected in the way the readmissions measures are reported,” said Atul Grover, chief of public policy for the Association of American Medical Colleges, one of the hospital groups supporting the measure.

The American Hospital Association endorsed the bill and announced it would push for its passage.

jrau@kff.org

This article was produced by Kaiser Health News with support from The SCAN Foundation.