Question

Please explain the readmissions penalties as outlined under the Patient Protection and Affordable Care Act (PPACA). What has been the response of acute care providers (i.e.) hospitals in the face of readmission penalties? Has the readmission penalties had a neutral, positive, or negative effect on the post-acute care industry. Why? ( use external information from respectable sources to support your answer)

Answer 1

Ans) It's sometimes known as “PPACA,” “ACA,” or “Obamacare.”) The law provides numerous rights and protections that make health coverage more fair and easy to understand, along with subsidies (through “premium tax credits” and “cost-sharing reductions”) to make it more affordable.

- Reduce Medicare payments that would otherwise be made to hospitals by specified percentages to account for excess (preventable) hospital readmissions. (Effective October 1, 2012)
Reduce Medicare payments to certain hospitals for hospital-acquired conditions by 1%. (Effective fiscal year 2015)

- Reductions in hospital readmissions (also referred to as rehospitalizations) have been identified by Congress and President Obama as a source for reducing Medicare spending. The Medicare Payment Advisory Commission (MedPAC) reported that in 2005, 17.6% of hospital admissions resulted in readmissions within 30 days of discharge, 11.3% within 15 days, and 6.2% within 7 days.

- In addition, variation in readmission rates by hospital and geographic region suggests that
some hospitals and geographic areas are better than others at containing readmission rates.
People who are readmitted to the hospital tend, among other things, to be older and have multiple chronic illnesses.

- Yet much is unknown about which patient characteristics result in a higher probability of a hospital readmission. Some policy researchers and health care practitioners assert that the relatively high readmission rates for patients with chronic illness and others may be due
to various factors, such as an inadequate relay of information by hospital discharge planners to
patients, caregivers, and post-acute care providers; poor patient compliance with care
instructions; inadequate follow-up care from post-acute and long-term care providers;
variation in hospital bed supply; insufficient reliance on family caregivers; the deterioration of a patient’s clinical condition; and medical errors.
- Although readmitting a patient to a hospital may be appropriate in some cases, some policy
makers and researchers agree that reducing readmission rates could help contain Medicare costs and improve the quality of patient care. Although several entities have attempted to define just how many readmissions might be prevented, no consensus exists on how to distinguish among those readmissions that might be avoided and those that might not. Different approaches result in different potentially preventable readmission (PPR) rates.
On March 23, 2010, President Obama signed into law comprehensive health care reform
legislation, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act.

- The legislation contains a number of provisions that make changes to Medicare. Among these are provisions intended to reduce preventable hospital readmissions by reducing Medicare payments to certain hospitals with relatively high preventable readmissions rates.

- Otherprovisions include demonstrations and pilots that test reforms to the Medicare payment system for hospitals and other providers. And still others test improvements to patient care for people with chronic illnesses during the initial hospital stay, as patients transition out of the hospital, and while patients reside in home, community-based, Medicare post-acute care, and long-term care settings.
- Some service delivery and financing reform strategies have the potential to improve the quality of care delivered to Medicare beneficiaries with chronic conditions, and may even reduce hospital readmission rates.

- Althoughsavings from reducing readmissions may be considerable, this potential depends on the effectiveness of the design and implementation of proposals to reduce
them.