For the past eight years, the Centers for Medicare & Medicaid Services has run an annual oversight program of accredited hospitals called the Hospital Readmissions Reduction Program.
The Program publishes standards that hospitals are required to meet each year. The aim of the Program is to get the maximum bang for Medicare’s buck in terms of patient safety and reducing the rate of patient readmission to the hospital within 30 days of an initial discharge from hospitalization.
The program provides an opportunity for a win-win. Medicare pays less for repeat hospitalizations that may often be avoided with quality care. And, of course, patients win by receiving safer care.
Medicare requires hospitals to provide their data and then compares each hospital to the expected readmission rates for the following conditions and procedures:
• Acute myocardial infarction (heart attack)
• Chronic obstructive pulmonary disease (COPD)
• Heart failure
• Coronary artery bypass graft surgery
• Elective (non-emergency) primary total hip arthroplasty (replacement)
• Elective total knee arthroplasty
The teeth in the program come in the form of Medicare payment reductions for an entire year. As a former hospital administrator, I can assure you that programs like this get the attention of hospital leaders. If hospitals want to stay in business, they have to improve their performance.
The worst of the worst performing hospitals nationwide are hit with the maximum reduction of the Medicare reimbursement rate, which is currently capped at 3%.
In the October 2019 listing, there were 10 Texas hospitals at the bottom of the barrel performance-wise under Medicare’s Hospital Readmissions Reduction Program, including these four hospitals in the Houston area:
• Sugar Land Surgical Hospital
• Memorial Hermann Surgical Hospital Kingwood
• Houston Physicians’ Hospital, in Webster
• St. Luke’s Lakeside Hospital, in The Woodlands
If you’ve been seriously injured because of poor hospital care, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help with your potential case.