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2583 hospitals hit with penalties due to readmission reduction program

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Medicare hit 2583 health systems with penalties by cutting payments to them. This has been happening for the last eight years and thanks to the ACA, it is an effort to reduce the readmission rates of hospitals. This specifically focuses on the patients who return within the same month after they are primarily discharged which helps the readmission reduction program.

This is not something new, as it is a recurrent theme for the last few years, where Medicare predicts that it’ll cost the hospitals a whopping $563 million per year. This effort to reduce readmissions is known as the Hospital Readmission Reduction Program and has about 3129 hospitals attached to it. Out of them, a staggering 83% could not reduce the readmission rate and thus, were slapped with the penalties. This penalty to each of these hospitals will be in the form of deductions from the payments Medicare will pay them for future patients over the next year, starting this October 1st.

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One thing has been repeatedly said that these efforts have been going on for quite some time, since 2012, to be precise. However, many are still unclear whether these fines are helping to reduce readmission rates and thus generating better patient safety. On the other hand, these efforts have been reinforcing hospitals and health systems to reimagine how the patients are receiving care and focus on their health after discharging them so that minimal readmissions occur. Conversely, many industry pundits have chimed in that a few healthcare providers may intentionally avoid readmitting patients who require critical post-discharge healthcare services solely because of these penalties, which is severely detrimental for the patient’s health as well the hospitals’ reputations. Others are saying the program itself is not that effective, although it has brought in small benefits. 

Some studies were conducted, and it was revealed that this HRRP caused an increase in fatal incidents regarding patients. However, it was refuted by a study conducted by the Medicare Payment Advisory Commission (MedPAC).

Sometime last month, MedPAC’s study was released to the public, and it showed that the number of readmissions of Medicare patients within a timeframe of 30 days decreased to 15.7% in 2017 from 16.7% in 2010. 

Going into specifics, the hospitals are penalized for these readmissions when the patients are provided with healthcare services for heart failure, pneumonia, heart attack, hip and knee replacement, chronic coronary artery bypass graft surgery, or lung disease. One good thing regarding HRRP is that inevitable readmissions, for instance, scheduled ones, are exempted from penalties. Delving deeper, HRRP dictates that if patients return within the 30 days timeframe, the hospital will be penalized. Also, if the Medicare-funded patients go to a different hospital, the primary hospital which provided the care will be penalized. 

According to KHN, about 1177 hospitals were penalized higher than they were compared to last year, whereas 1148 received lower penalties compared to the previous period. 64 providers were stable since they received the same amount of penalty compared to last year. 194 new hospitals were added to the list of penalized hospitals, whereas 372 exemplary hospitals received no penalties for two consecutive years. However, one thing must be noted – 2142 health systems and hospitals were exempted due to the lower number of cases, veterans, or children’s hospitals. 

So, the readmission reduction program is one of the biggest headaches of hospitals and health systems. How can they be reduced? Well, a lot of health systems are using RightPatient to address it. It is a biometric patient identification platform that locks the medical records of the patents with their biometric data and the records cannot be accessed without biometrics. Other than ensuring positive patient identification, it also ensures that the hospitals receive a notification when a patient enters their premises within the 30-day period so that they can be provided with better care and thus ensuring better patient experience, reducing the penalties as well as better patient outcomes and thus, minimizing losses while creating a win-win situation for all.

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Another industry expert in favor of an effective patient identifier

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It has been a long, continuous, and never-ending fight for the unique patient identifier which has not been without its own share of controversies. At the moment, Congress is thinking about whether it should give the green signal regarding the financing of a unique patient identifier to be used across the health systems and hospitals in the US. Now, Julie Dooling, another prominent healthcare expert of the American Healthcare Information Management Association (AHIMA), has given her views regarding how an effective patient identification platform can change the game. Such a solution can generate accurate patient identifications with the existing electronic health records within any hospital that aims at helping and improving patient safety as well as to eliminate any detected fraud in the process. Thankfully, such a solution exists – more on that later.

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Patient matching – how hard could it be. That’s what may come to the minds of many. However, the truth is precisely the opposite when it comes to matching patients to their actual records, let alone duplicates which may be exceptionally complicated and thereby, making the failure rate to be quite significant. Moreover, according to Ms. Dooling, 8-12% of errors exist due to the duplicate records created for the same patient. Here is where the patient identification solution will come into play and it will identify the correct records for the patients every time, according to her.

However, it is not only AHIMA – a lot of health systems, hospitals, as well as other prominent healthcare organizations have been clamoring for a solution and are thus demanding for the abolishment of the archaic ban on funding and researching for a unique patient identifier by the Department of Health and Human Services which could be used nationwide.

HIPAA came into effect in 1996 and had a prerequisite for making reliable patient identification systems so that meaningful health information could be generated. However, as said multiple times, privacy concerns were cited by many parties, which ultimately led to the restriction in the development and funding for a national patient identifier. The opposition reasoned that medical records would be exposed and cybercriminals could steal data.

However, that did ultimately happen, and we see news regarding such cybercrimes every day. Also, fraudulent activities are quite common regarding the health information of patients. Ms. Dooling says that the consequences of privacy concerns such as healthcare fraud, which were given as reasons for not opting for a UPI, are happening even without its existence. Ms. Dooling also added that if a UPI is to be made, as everyone is clamoring for it now, it will take a lot of effort since it has to be nationwide and also should have interoperability, which is the primary concern. She also stated her concern regarding privacy issues; they would not be collecting Social Security Numbers so that the people can heave a sigh of relief regarding this matter.

Funding, researching, and creating such a solution would take a lot of time and resources. However, what if such a solution exists? Wouldn’t it be that much more feasible? Fortunately, such an exact solution exists.

A lot of health systems are already using RightPatient, which was made with accurate patient identification in mind. It is a biometric patient identification platform that locks the patient records with the biometric data of the patients. Once a patient registers their biometric data using RightPatient, it gets attached to their EHRs, and they can be identified within seconds whenever they visit the hospital. Also, this reduces medical identity theft and the medical records cannot be accessed without the biometric data of the patients, which can be irises or fingerprints. Likewise, health systems are using RightPatient to reduce denied claims as well, since they are eliminating patient misidentifications within their premises. It improves patient safety, enhances revenue cycle, and reduces millions of losses while saving both lives and money in the process. It does fit the bill for being a UPI since it is a tried and tested solution for accurate patient identification.

Source: Making the Case for National Unique Patient ID

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Why should the Senate choose biometrics as a unique patient identifier?

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Unique patient identifiers have been talked about several times, not only in this space but also everywhere else in the US – especially quite recently. This is because there have been positive signs which might finally grant the health systems and hospitals alike with the mythical unique patient identifier, which is sorely needed in the healthcare industry for positive patient identification. But why is it so badly needed? What are the problems faced due to patient misidentification? What will be the benefits? What can be a viable unique patient identifier in healthcare? Let’s explore these questions.

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One does not need even to imagine losing someone close and dear due to patient misidentification – these stories have been all over the news for years, and there’s no stopping them, unfortunately. Whenever you turn on the television or watch healthcare-related news on your smartphone or tablet, you’ll see at least one problem which has been caused by patient misidentification. It might be medical ID theft, insurance fraud, patient mix-up, a denied claim, or in extreme cases, death. These are just some of the real-life examples which have occurred over the years and are also very valid reasons why a proper patient identification system should be in place for health systems all over the US. For instance, there was once a case where a patient was misidentified and was denied care due to the wrong medical record being pulled. Or, take the opioid crisis – an addictive medication can inadvertently be suggested to patients who are addicts. 

These are scenarios that could have easily been avoided if only the patients were identified accurately and matched with their appropriate records. Over one hundred health systems are already doing that, but more on that later. Thanks to the recent talks regarding UPIs, the US Senate has a unique chance to do something about it and save lives as well as healthcare costs. It has the opportunity to do that when the members get to vote on Senate Fiscal Year 2020 Labor, Health & Human Services, & Education & Related Agencies Appropriations bill. Back in June, positive news spread throughout the news portals that the House of Representatives passed an amendment regarding the removal of the old ban on the creation of an effective UPI that can be used across the health systems of the US. However, everything now rests on the US Senate to make this a reality by creating a UPI or adopting something across the lines which have been helping to identify patients accurately.

What happened previously?

It has been around twenty years since the previous talks regarding unique patient identifiers occurred, which have resulted in zero progress. This has caused major problems regarding patient misidentification like medical errors, as well as insurance fraud, medical ID theft, and in extreme cases, and deaths of unfortunate patients. Earlier, patient misidentifications were overlooked, but recently, everyone recognizes it as a serious threat to patient safety – even a prominent entity like the ECRI institute has listed patient misidentification as one of the biggest impediments to effective patient safety.

However, that’s not all. The absence of a proper patient identification system also causes problems for healthcare providers, as well. As previously mentioned, insurance frauds, as well as denied claims, and increased losses are quite common issues for health systems, hospitals, and physician practices, as well as ACOs. Conventional EHRs have also shown an absence of interoperability, due to which the healthcare providers cannot share the same information regarding the same patient who may need to go to different health systems for various ailments.

Some statistics

A study conducted in 2016 states that patient misidentification costs any given healthcare provider approximately $17.4 million yearly, as a result of denied claims, thus cutting down their revenue. According to the study, the more pressing issue is that these misidentifications not only cause losses but also hamper patient safety. The same survey states that 26% of the sample had witnessed a medical error firsthand or at least have known about it, which were generated by misidentifications.

What should be the unique patient identifier in healthcare?

Thus, it is seen how vital an effective patient identification system is for the healthcare industry. But what should the Senate choose as a unique patient identifier in healthcare and why? RightPatient is the answer. It is a biometric patient identification system that over one hundred respectable health systems are using, such as Novant Health, Duke Health, UMC, and TGMC. All of them are providing the same feedback – better patient experience, enhanced patient safety, and improved patient matching, all of which lead to reduced duplicate medical records as well as reduced insurance fraud. A patient only needs to register into RightPatient using their biometric data like their fingerprints or irises – afterward, they are identified within seconds, and their appropriate medical record is pulled from the EHR system. Thus, RightPatient seems like the perfect candidate to be a unique patient identifier in healthcare since it has the capability as well as the experience and proven track record to be one.