Is Your Hospital Naughty or Nice?

August 14, 2012
William Balfour

healthcare data analyticsChristmas is coming a little early this year and it seems like most hospitals are going to find coal in their stockings.

Starting October 1, 2012 (that’s 2.5 months from now!), CMS will penalize 2,211 hospitals (out of 3,367) a combined total of $280M. The infraction? High readmission rates for inpatients with diagnoses of Pneumonia, CHF and AMI.

According to the Kaiser Health News, penalties range from 0% – 1% of Medicare reimbursments, with the most severe penalty of 1% bestowed upon 278 lucky hospitals.

1,156 hospitals were on the “nice” list and did not incur any readmission penalty from CMS.

Is your hospital on the naughty or nice list?
Check out Kaiser Health News’ penalty list hereTM Would you like that list in a CSV file? Go to the KHN article on Readmission penalties, scroll to the bottom and download the CSV file.

The New Healthcare means that hospitals must demonstrate, through metrics, their healthcare value to the populations they serve. Readmission penalties are just one way that CMS is pursuing higher value – lower costs and improved quality – healthcare. Other CMS programs including Value-Based Purchasing and Hospital Acquired Conditions spotlight the value focus of CMS.

In 2015, if you are a poor performer in all three programs, your bottom line will suffer due to:

  • 5% penalty applied to your Medicare reimbursements AND
  • No CMS reimbursement for care provided as a result of Hospital Acquired Conditions AND
  • Your costs to treat patients with an HAC will be higher than those without.

A triple-threat to your bottom line in an era where Medicare reimbursements are likely to decline as a matter of course.

Staying on the nice list
iVantage Health has tools to help you stay on the CMS nice list. Our Cost of Off-Quality cascade shows you which Hospital Acquired Conditions are most costly and allows you to drill down to the case level to look for patterns and quality issues. The VBP Scorecard shows, by indicator, where the biggest gap in your performance is. Our Quality Benchmarks allow hospitals to drill into the details of cases and procedures to engage clinicians in crafting solutions.

iVantage excels at helping hospitals translate data to action via the KnowledgeWeb. Links in all our tools show clinicians and managers what others have done to improve. The KnowledgeWeb goes further and connects you with peers at other hospitals to collaborate and strategize on difficult challenges.

Hospitals have two reasons to strive for the CMS nice list – money and, most importantly, better care for their patients. iVantage helps you do both.

iVantage KnowledgeWeb members can click the links below to learn what peers have done to reduce readmission rates!

Survey: Decreasing Pneumonia Readmissions

iConference: Decreasing CHF Readmissions

SGI (Successes & Good Ideas): Intermountain Reduces Pneumonia Readmissions and LOS

Survey: AMI, CHF and PN Readmission Rates

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