Emergency care leading to hospital readmission rates within 30 days of a prior discharge will be penalized by Medicare and Medicaid in the form of reduced payments. The costs associated such readmission penalties will likely run into the millions of dollars. Two thirds of U.S. hospitals (2,211hospitals) will be penalized starting in 2013. Two hundred seventy eight (278) facilities have already been told that they will receive the maximum penalty of a 1% reduction in payments, which means millions less in payment to penalized hospitals. For example in Tennessee, Vanderbilt University Medical Center expects to be penalized between $500,000 and $1,000,000 a year, and Saint Thomas Health Hospital expects to lose about $1.2 million dollars a year in payments. Because every dollar lost hurts hospital operations, there will be increased pressure on Emergency Room physicians to not readmit recently discharged patients who need care.
Although some readmissions are genuinely related to poor quality, such as infections, surgical complications, blood clots and surgical hardware failures, about 25% of readmissions are not related to poor care and should not be calculated as part of the penalty. Patients get sick after discharge - sometimes because of the nature of the underlying problem, and sometimes because of a second health problem that arises afterwards. Some surgeries are two stage procedures that require two operations within 14 to 21 days.Regardless of the reason, Medicare and Medicaid payments to hospitals will be reduced if patients are readmitted within 30 days of discharge.
Each year, millions of people go to hospitals for emergency care expecting that decisions to treat and release or to admit are determined by an objective medical assessment. The Readmission Reduction Act will put financial pressure ER physicians to discharge patients who otherwise should be admitted. Unfortunately, determining payment penalties on "all cause" admission rates is not realistic and will cause more patients to suffer Emergency Room malpractice injuries.