Mitigating Increasing Readmissions to Avoid Reduced Reimbursement

CMS released the results for year five of the Hospital Readmissions Reduction Program.  Here is what you need to know:

  • What was covered? CMS examined hospitals’ 30-day readmission rates for seven conditions:
    • Heart attacks
    • Heart failure
    • Pneumonia
    • Chronic lung disease
    • Hip and knee replacements
    • Coronary artery bypass graft surgery
  • What is the average penalty? The average reduction to hospitals was 0.73% for each Medicare payment, up from 0.61% last year resulting in an increase of approximately $108 million.
  • How many facilities are impacted?  CMS will penalize 2,597 facilities in FY 2017 and of those it is reported that 1,621 hospitals have faced penalties every year of the program.
  • How were penalties determined? CMS determines reasonable readmission rates based on national rates and demographic health and compares a hospital’s reported readmission rate. Hospitals with more unplanned readmissions than expected will receive a reimbursement reduction for each Medicare case during the upcoming fiscal year (October 1 – September 2017).

How can your hospital mitigate unexpected readmissions?  Understand the reasons for readmission and implement practical solutions.  Using our auditing tools and DocEdgeTM Communicator platform, Provident can help your facility identify the root cause of readmissions and implement effective and efficient communication platforms inside and outside of the hospital to prevent unnecessary readmissions.

To learn more, visit our website at or contact Valerie Reich at

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