The federal government has turned its attention to hospital readmission rates in its ongoing efforts to improve the quality of medical care and prevent medical errors, the most common cause of paid claims for malpractice.
Section 3025 of the Affordable Care Act (ACA) establishes the Hospital Readmissions Reduction Program, which authorizes the Centers for Medicare & Medicaid Services (CMS) to reduce payments to certain hospitals with high readmission rates. CMS will specifically penalize hospitals with high rates of patients who return to the hospital within a month of discharge for some of the most commonly misdiagnosed conditions: heart attack, heart failure, and pneumonia.
According to an article by the Kaiser Health News, millions of Medicare beneficiaries are readmitted within a month of discharge from the hospital each year, costing Medicare $17.5 billion in additional hospital-based costs. Although many hospitals have worked hard to put measures in place to reduce their rate of readmission, the national average readmission rate remains high.
This October, hospitals will experience millions of dollars in penalties due to high readmission rates. Illinois hospitals will be hard hit, with 89 percent of hospitals facing readmission penalties.
Recent JAMA Article Casts Doubt
High readmission rates have been linked to poor healthcare quality, and the heavy fines levied against hospitals with high readmission rates support that link. However, a recent Journal of the American Medical Association study argues that higher hospital readmissions can be caused by factors other than poor healthcare quality, including a hospital’s patient demographics and non-compliance by patients. This study and other research raises doubt as to whether high readmission rates are literally the “canary in the coal mine.”
Healthcare Consumers Should Do Their Homework
Nonetheless, healthcare consumers in Illinois can still use readmission rates to reduce their risk of medical malpractice and misdiagnosis. “On the face of it, they tell you how a hospital and the post-acute care that a patient gets after leaving worked, how well they performed in making sure patients follow everything that they need to do to recuperate from whatever brought them into the hospital.”, says Jordan Rau, a Kaiser Health News reporter who has written extensively about hospital readmission penalties. Rau suggests that consumers use the readmission rates, which are publicly available, as one of several factors to consider when choosing a hospital.
Hospital Readmission and Legal Claims
Unfortunately, even the most well informed healthcare consumer may face an unplanned return to the hospital due to medical errors. If you or a loved one have suffered injuries related to readmission to a hospital, you have the right to explore your legal options. Our medical malpractice attorneys who have long represented clients injured or killed by the careless or intentional acts of healthcare providers can well-equipped to evaluate your specific circumstances and determine whether you have grounds to sue a hospital or an individual healthcare provider for medical malpractice.
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