Will Medicare Readmission Penalties Motivate Hospitals to Reduce Arthroplasty Readmissions?

R. Carter Clement, Caitlin M. Gray, Michael M. Kheir, Peter B. Derman, Rebecca M. Speck, L. Scott Levin, Lee A. Fleisher

Research output: Contribution to journalArticle

Abstract

Background: The Centers for Medicare & Medicaid Services (CMS) recently imposed penalties against hospitals with above-average 30-day readmission rates following total joint arthroplasty (TJA). Hospitals must decide whether investments in readmission prevention are worthwhile. This study examines the financial incentives associated with unplanned readmissions before and after invocation of these penalties. Methods: Financial data were reviewed for 2028 consecutive primary TJAs performed on Medicare beneficiaries over a 2-year period at an urban academic health system. Readmission penalties were estimated in accordance with CMS policies. Results: Unplanned readmissions generated a $4416 median contribution margin. The initial hospitalizations (when the TJA was performed) were financially unfavorable for patients subsequently readmitted relative to those not readmitted due to increased costs of care (P = .002), but these costs were more than outweighed by the increased reimbursement earned during the readmission (P < .001), ultimately making readmitted patients financially preferable (P < .001). Going forward, penalties will be levied for risk-adjusted readmission rates above the national rate of 4.8%. For the institution under review, the penalty per readmission outweighs the financial gains earned through readmission by $12,184, resulting in a net loss from readmissions if the rate exceeds 6.5%. It will be financially optimal to maintain a readmission rate (after risk adjustment) equal to the national average but exceeding that rate will be $7768 more expensive per readmission than undershooting that target. Conclusion: If our results are generalizable, unplanned Medicare readmissions have traditionally been financially beneficial, but CMS penalties outweigh this benefit. Thus, penalties should incentivize institutions to maintain below-average arthroplasty readmissions rates.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Apr 19 2016
Externally publishedYes

Fingerprint

Risk Adjustment
Medicare
Arthroplasty
Joints
Urban Health
Costs and Cost Analysis
Medicaid
Motivation
Hospitalization

Keywords

  • Reimbursement penalties
  • The Centers for Medicare & Medicaid Services (CMS)
  • Total hip arthroplasty (THA)
  • Total joint arthroplasty (TJA)
  • Total knee arthroplasty (TKA)
  • Unplanned readmissions

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Clement, R. C., Gray, C. M., Kheir, M. M., Derman, P. B., Speck, R. M., Levin, L. S., & Fleisher, L. A. (Accepted/In press). Will Medicare Readmission Penalties Motivate Hospitals to Reduce Arthroplasty Readmissions? Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2016.08.031

Will Medicare Readmission Penalties Motivate Hospitals to Reduce Arthroplasty Readmissions? / Clement, R. Carter; Gray, Caitlin M.; Kheir, Michael M.; Derman, Peter B.; Speck, Rebecca M.; Levin, L. Scott; Fleisher, Lee A.

In: Journal of Arthroplasty, 19.04.2016.

Research output: Contribution to journalArticle

Clement, R. Carter ; Gray, Caitlin M. ; Kheir, Michael M. ; Derman, Peter B. ; Speck, Rebecca M. ; Levin, L. Scott ; Fleisher, Lee A. / Will Medicare Readmission Penalties Motivate Hospitals to Reduce Arthroplasty Readmissions?. In: Journal of Arthroplasty. 2016.
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abstract = "Background: The Centers for Medicare & Medicaid Services (CMS) recently imposed penalties against hospitals with above-average 30-day readmission rates following total joint arthroplasty (TJA). Hospitals must decide whether investments in readmission prevention are worthwhile. This study examines the financial incentives associated with unplanned readmissions before and after invocation of these penalties. Methods: Financial data were reviewed for 2028 consecutive primary TJAs performed on Medicare beneficiaries over a 2-year period at an urban academic health system. Readmission penalties were estimated in accordance with CMS policies. Results: Unplanned readmissions generated a $4416 median contribution margin. The initial hospitalizations (when the TJA was performed) were financially unfavorable for patients subsequently readmitted relative to those not readmitted due to increased costs of care (P = .002), but these costs were more than outweighed by the increased reimbursement earned during the readmission (P < .001), ultimately making readmitted patients financially preferable (P < .001). Going forward, penalties will be levied for risk-adjusted readmission rates above the national rate of 4.8{\%}. For the institution under review, the penalty per readmission outweighs the financial gains earned through readmission by $12,184, resulting in a net loss from readmissions if the rate exceeds 6.5{\%}. It will be financially optimal to maintain a readmission rate (after risk adjustment) equal to the national average but exceeding that rate will be $7768 more expensive per readmission than undershooting that target. Conclusion: If our results are generalizable, unplanned Medicare readmissions have traditionally been financially beneficial, but CMS penalties outweigh this benefit. Thus, penalties should incentivize institutions to maintain below-average arthroplasty readmissions rates.",
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AU - Clement, R. Carter

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AB - Background: The Centers for Medicare & Medicaid Services (CMS) recently imposed penalties against hospitals with above-average 30-day readmission rates following total joint arthroplasty (TJA). Hospitals must decide whether investments in readmission prevention are worthwhile. This study examines the financial incentives associated with unplanned readmissions before and after invocation of these penalties. Methods: Financial data were reviewed for 2028 consecutive primary TJAs performed on Medicare beneficiaries over a 2-year period at an urban academic health system. Readmission penalties were estimated in accordance with CMS policies. Results: Unplanned readmissions generated a $4416 median contribution margin. The initial hospitalizations (when the TJA was performed) were financially unfavorable for patients subsequently readmitted relative to those not readmitted due to increased costs of care (P = .002), but these costs were more than outweighed by the increased reimbursement earned during the readmission (P < .001), ultimately making readmitted patients financially preferable (P < .001). Going forward, penalties will be levied for risk-adjusted readmission rates above the national rate of 4.8%. For the institution under review, the penalty per readmission outweighs the financial gains earned through readmission by $12,184, resulting in a net loss from readmissions if the rate exceeds 6.5%. It will be financially optimal to maintain a readmission rate (after risk adjustment) equal to the national average but exceeding that rate will be $7768 more expensive per readmission than undershooting that target. Conclusion: If our results are generalizable, unplanned Medicare readmissions have traditionally been financially beneficial, but CMS penalties outweigh this benefit. Thus, penalties should incentivize institutions to maintain below-average arthroplasty readmissions rates.

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