A proposed bill in the House of Representatives could ease readmissions penalties on hospitals that treat a high percentage of dual eligible patients if it becomes law, according to the office of Rep. Jim Renacci.
The bill, “Establishing Beneficiary Equity in the Hospital Readmission Program Act,” would limit penalties for dual eligible (Medicare-Medicaid) beneficiaries, the nearly 9 million Americans who have low incomes and are afflicted with complex, multiple comorbidities. They also are a high-risk group for being frequently readmitted to hospitals, noted Rep. Renacci, who is a former owner and operator of nursing homes.
The bill would prevent hospitals that treat many dual eligibles from being unfairly targeted under the Affordable Care Act (ACA), which implemented penalties or hospitals with readmissions rates above an acceptable threshold.
The American Hospital Association supports the measure. In a press release, they state that the bill would help ensure that hospital performance improvement efforts are focused on readmissions that are preventable.
“Many poorer communities have large gaps in crucial community services to support patients when they are released from the hospital, such as the availability of fresh foods with high nutritional value, public transportation for necessary medical check-ups and assistance in getting other types of much needed and proper follow-up care. And many patients simply don’t have the resources for medicines and other supplies necessary to ensure recovery from illness and injury. As a result, hospitals serving these neighborhoods often have higher numbers of readmitted patients and are penalized for factors beyond their control.”
Source: American Hospital Association, March 11, 2014
Moving Beyond the Medical Care Coordination Model for Dual Eligibles a March 12th webinar, presented Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation, who shared her organization’s approach to designing a care coordination model for dual eligibles and initial findings from these new programs.