What is the Medicare 30-day readmission rule?

What is the Medicare 30-day readmission rule?

Medicare counts as a readmission any of those patients who ended up back in any hospital within 30 days of discharge, except for planned returns like a second phase of surgery. A hospital will be penalized if its readmission rate is higher than expected given the national trends in any one of those categories.

What counts as a 30-day readmission?

The HRRP 30-day risk standardized unplanned readmission measures include: Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. Patients who are readmitted to the same hospital, or another applicable acute care hospital for any reason.

Does scheduling discharge appointments affect readmissions?

Conclusions: The postdischarge appointment service resulted in a substantial increase in timely PCP followup, but its impact on the readmission rate was less clear.

Does Medicare penalize hospitals for readmissions?

For the readmission penalties, Medicare cuts as much as 3 percent for each patient, although the average is generally much lower. The patient safety penalties cost hospitals 1 percent of Medicare payments over the federal fiscal year, which runs from October through September.

What is considered a readmission?

A hospital readmission is an episode when a patient who had been discharged from a hospital is admitted again within a specified time interval. Readmission rates have increasingly been used as an outcome measure in health services research and as a quality benchmark for health systems.

What is the Medicare 2 midnight rule?

The Two-Midnight rule, adopted in October 2013 by the Centers for Medicare and Medicaid Services, states that more highly reimbursed inpatient payment is appropriate if care is expected to last at least two midnights; otherwise, observation stays should be used.

How does CMS define a readmission?

The 30-day All-Cause Hospital Readmission measure is a risk-standardized readmission rate for beneficiaries age 65 or older who were hospitalized at a short-stay acute-care hospital and experienced an unplanned readmission for any cause to an acute care hospital within 30 days of discharge.

How are readmissions calculated?

Readmission rate: number of readmissions (numerator) divided by number of discharges (denominator); each readmission should be counted only once to avoid skewing the rate with multiple counts.

What is post-discharge follow-up?

Relevant post-discharge follow-up was defined as outpatient, non-emergency department telephone calls or clinic visits with internal medicine, family medicine, or cardiology providers.

How many readmissions occur within 90 days of discharge from hospitals?

Condition-specific 30- and 90-day readmission rates by post-acute discharge setting are presented in Table 1. For patients with stroke, 30-day readmission rates ranged from 8.8% in HHAs (ischemic) to 14.4% in SNFs (hemorrhagic) and 90-day rates ranged from 18.2% in HHAs (ischemic) to 26.1% in SNFs (hemorrhagic).

What type of patients would be excluded in a readmission rate?

Index admissions are excluded from the readmission measure if they meet one of the following: The patient was discharged against medical advice (AMA) The patient was admitted for a primary psychiatric diagnosis, for rehabilitation, or for medical treatment of cancer.

What is not an exception to the two midnight rule?

Hospital treatment decisions for beneficiaries are based on the medical judgment of physicians and other qualified practitioners. The Two-Midnight rule does not prevent such practitioners from providing any service at any hospital, regardless of the expected duration of the service.