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Hospitals with high patient readmissions penalized through CMS reimbursement program

December 11, 2012
Uncategorized By LW Consulting Inc.

Hospital providers will need to develop healthcare strategic planning initiatives in order to handle the various new legislations and regulations within the healthcare industry. The federal government, with major assistance from the Department of Health and Human Services (HHS) as well as the Centers for Medicare and Medicaid Services (CMS), have instituted meaningful use regulations for the installation of electronic health records (EHRs) and ICD-10 compliance in order for hospitals to have a thorough, advanced set of medical codes.

HIPAA compliance is also a major part of the regulations medical facilities need to follow, as with EHR implementation, computer systems expose patient data to the pitfalls of security risks. Protecting healthcare information through encryptions, staff education or training and other methods for avoiding HIPAA violations are vital protocols for any healthcare organization.

Modern Healthcare reported that hospitals will also be experiencing issues with legislation that focuses on patient readmission rates. Facilities that have a high readmission rate will not gain as much reimbursement from CMS and will be penalized in this way.

"We thought we could cut readmissions in half five years ago when we began," Dr. Bill Conway, chief quality officer with Henry Ford Health System in Detroit, told the news source. "Now we get below 18 percent and are happy with it. There are 100 things that need to go well to reduce readmissions [and many] are out of our control."

National studies have shown that minorities and the poorest of the population are more likely to be readmitted to hospitals because of lack of health insurance or a primary care doctor. By working with a hospital consultant, healthcare organizations will be more likely to keep hospital readmission rates low and gain necessary reimbursements as well as meet ICD-10 compliance and meaningful use requirements.