Controversy Over CMS Readmission Reduction Program Heats Up – Anesthesia Prepares




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In the last year or so there has been much discussion and debate over the Medicare payment penalties for hospital readmissions. In last month’s issue of Healthcare Financial Management Association Magazine (HFM), authors Richard F. Averill, Norbert Goldfield, and John S. Hughes of 3M Health Information Systems decided to sound-off on the controversial topic, providing readers with another side to the readmission fee debate in their article “Medicare Payment Penalties for Unrelated Readmissions Require Second Look.”

For readers unfamiliar with the newest program from the Centers for Medicare and Medicaid Services (CMS) regarding hospital readmission fees, here is a quick run-down:

•     CMS created a program called the Hospital Readmissions Reduction Program.

•     The intention of this program was to prevent Medicare/Medicaid payments to hospitals for readmissions that could have been prevented, theoretically increasing healthcare quality.

•     Program took effect for any hospital discharges on or after October 1, 2012.

•     Program assumes any readmission, whether related to original admission or not, could have been prevented if the correct measures and processes took place during the first admission.

According to Mr. Averill and Co., this program “holds hospitals responsible for readmissions over which they have little or no control.”  With readmissions not always having any connection to the original admission, the authors believe that this program is unfair to be all-inclusive in regards to readmission, no matter the specific circumstances. The authors go on further to point out various state laws and Affordable Healthcare Act regulations that contradict CMS’s all-inclusive policy. (

According to, proponents of the program were few at the Heart Failure Society of America (HFSA) 2013 Scientific Meeting; however, these supporters presented their side of the argument as well. Dr. Gregg C. Fonarow of UCLA, according to Medscape, was quoted as saying:

“It’s appropriate to provide incentives so we’re not just asking individuals to voluntarily do the right thing but to actually have a degree of accountability in the finances and not be rewarded for poor care….I do think overall the benefits of the measure outweigh the potential downsides. That doesn’t mean I don’t think it could not be improved upon.” ( article)

Whether or not the HRRP gains a majority support, it is certain that anesthesia services will be affected due to its omnipresence in most departments. The affects this will have on anesthesia departments and services are yet to be fully realized, however, it is still important to be aware of the HRRP and the impending consequences. Somnia Anesthesia’s founder and CEO, Marc E. Koch, had this to say about the CMS Hospital Readmissions Reduction Program:

“There are always intended and unintended consequences to any intervention. The DRG system seemingly encourages facilities to not be lackadaisical with discharges and (wrongly) presumes that clinicians and facilities will keep patients longer than they should be left to their own devices. The HRRP, on the other hand, seemingly encourages clinicians and facilities to not let patients go home too soon; Again, falsely presuming that clinicians are hustling patients out the hospital exit door. Overall, the aggregate seems to suggest that clinicians and facilities are being asked to thread an administrative needle, rather than mend a broken or infirmed patient, and now penalize them for taking a conservative, careful and cautious approach. The goal of discharging patients home only when they are ready, and trying to avoid needlessly returning them to the hospital too soon, is reasonable…but is exactly what every physician, nurse or clinician aims for, and the carrot/stick overlay seems oddly out of place”

We at Somnia Anesthesia will be paying close attention to any potential changes in the HRRP and the overall affects it has on anesthesia services around the country. We suggest that you do the same for the overall preparedness of your anesthesia department.

How is the HRRP affecting your anesthesia practice? Need to know how to best stay prepared for the affects of HRRP? Let us know below in the comments section or contact us here.

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