How Nursing Staff Can Help Reduce Medicare Readmission Penalties

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The Affordable Care Act incorporated sweeping series of reform initiatives focus on providing higher quality care. One oft he initiatives is known as the Medicare Readmission Reduction Program. The program is designed to “provide incentives for hospitals to implement strategies to reduce the number of costly and unnecessary readmission’s.” This requires hospitals to focus on care transition and adequate discharge planning which should lead to better quality care.

Why Does it Matter?

Hospitals are penalized for patients that are readmitted for certain heart conditions, COPD, hip and knee arthroplasty and pneumonia if a patient is readmitted within 3 0days of discharge from the previous hospital stay.  In 2014, over half of the hospitals in the United States had to pay the Medicare readmission penalties–money that could have been used to better advantage for the hospital. The payments amounted to$420 million which is an increase from the $227 million paid by hospitals in 2014. Readmission rates have declined to 17.5% after several years of 19.5% readmission rates.

Unfortunately, it can become a slippery slope. Once these penalties start then other penalties exist that Medicare imposes.The Medicare readmission penalty serves as a red flag item that alerts the government to check on a facility further. A correlation does exist between inadequate nursing staffing and penalties. According to NCBI, hospitals with a high level of nursing staff have 25%lower odds of being penalized. Conversely, even hospitals that provide good care do get penalized.  Reducing readmissions is a complex process because not all readmissions can be prevented. Socioeconomic factors and lack of access to supportive services can and do impact readmissions. But, increasing nursing staff may be a strategy that, by decreasing readmissions, may actually reduce costs.

When evaluating afacility it is appropriate to  check more than theMedicarereadmission rates. It is important to determine whatprograms, protocols,orprocesses have been initiated toalleviateor improve readmissions.Most readmission problems involvepersonnel.Methodsthatallowemployeestoreportissueswithout penaltiesandoffersolutionsresultinbetterfacilities,employeesatisfactionandfewer readmissions. Again, the purpose of imposing penalties is to improve care and lower costs. Both are important in today’s healthcare environment.

If you are interested in having the quality personnel you need to improve the quality of care in your facility, contact us at We would really like to talk with you.