Beware the FY 2015 Readmission Diagnoses

Beware the FY 2015 Readmission Diagnoses

The Affordable Care Act was upheld by the Supreme Court as constitutional in June 2012. In August 2012, The Centers for Medicare and Medicaid Services (CMS) issued its hospital inpatient prospective payment system revised for hospitals.

The most significant change was a reduction in the readmission rates for FY 2014 for the following diagnoses: Acute MI, Heart Failure, and Pneumonia.

CMS is finalizing the expansion of the applicable conditions for FY 2015 to include: patients admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD), and patients admitted for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Readmission is defined as an acute hospitalization for any of the previous mentioned diagnosis and a return to the hospital within 30 days.

Hospitals will receive a reduction in payment determined by the readmission rates and are now developing Accountable Care Organizations that will include home health agencies that work at keeping the readmission rate low.

In addition, CMS is considering a bundle payment controlled by the hospitals that is to be shared with the post-acute providers for any given patient, which will affect the reimbursement of home health agencies.

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