Hospitals Oppose Penalties For Preventable Readmissions

The Massachusetts Hospital Association is fretting that some of its members will soon get hit with a new state-sanctioned penalty for higher-than-expected patient readmissions.

In a 9-page letter from the MHA to the state Medicaid Director Dr. Julian Harris, the association calls the new penalty — which is slated to take effect Oct. 1 — "inexplicable and inexcusable."

It says those hospitals deemed to have readmissions numbers that are too high were given a 2.2% reduction to their inpatient SPAD," the Standard Payment Amount Per Discharge.

The Sept. 14 letter continues:

Hospitals and MHA find the preventable readmission payment penalty be an unsound and arbitrarily designed policy. It appears to be based on the simplistic and flawed premise that preventable readmissions are caused principally by hospitals. Responsibility and accountability for readmissions, as with most patient health issues, is shared among hospitals, ambulatory care providers, long-term care/post-acute care institutions, public and private payers (including MassHealth), patients themselves, and patients' families.

There are circumstances in which hospitals can be held accountable for readmissions, as when substandard care during a hospital stay leads to the need for patients to be rehospitalized. This circumstance is already addressed by MassHealth’s Serious Reportable Event (SRE) policy that prohibits payments for hospital and hospital-based physician inpatient and outpatient services when readmission or subsequent outpatient care can be traced unambiguously to hospital care system failures under the hospital’s control. There are other instances, however, when a readmission has nothing to do with the care initially provided at the hospital.

The readmission penalty is just one of many problems the MHA has with the new contract between the state and hospitals that provide health care to MassHealth patients. Another concern, according to the letter,  is "the continued dramatic underfunding of the MassHealth program, which MHA estimates will result in the state paying providers only 71% of the cost of care provided to MassHealth patients."

Catherine Bromberg, a spokesperson for the MHA says that while specific hospitals were notified about their preventable readmission rates and penalties that information is not public.

I called MassHealth for a comment, but haven't gotten one yet.  I'll update when I do.

This program aired on September 20, 2011. The audio for this program is not available.

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Rachel Zimmerman Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for WBUR. She is working on a memoir about rebuilding her family after her husband’s suicide. 



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