CMS misclassified penalties for nearly a third of hospitals in readmissions program, study finds

Penalties for up to 31 percent of hospitals in CMS' Hospital Readmissions Reduction Program were misclassified last year, according to a study published in JAMA Cardiology.

For the cross-sectional study, the authors estimated the rate at which penalties were misclassified for hospitals in the readmissions program for fiscal year 2019. The authors used 2014-17 data from CMS' Hospital Compare website. The data included information from 1,633 hospitals that discharged Medicare beneficiaries with heart attacks, 2,626 hospitals for heart failure and 2,705 hospitals for pneumonia. Hospitals were included if they had at least 25 discharges per condition. 

The authors found the percentage of hospitals that should have been penalized but weren't was 20.9 percent for heart attacks, 13.5 percent for heart failure and 13.2 percent for pneumonia. Vice versa, 10.1 percent were incorrectly penalized for heart attack, 10.9 percent for heart failure and 12.3 percent for pneumonia.

The authors concluded "the margin of error associated with the 30-day [risk-standardized readmission rates] resulted in the misclassification of condition-specific penalty status for up to 31 percent of hospitals. These findings suggest that the hospital-level 30-day [risk-standardized readmission rate] measure may not reliably distinguish hospital performance in the HRRP. This has important implications for CMS value-based programs that use risk-standardized outcomes to evaluate and compare hospital performance."

Read more here.

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