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Reimbursement Feature

Image created by RRY Publications, LLC / Sources: Wikimedia Commons, Jeramey Jannene and Jon Eban Field

Joint Replacement Readmission Penalty $265, 000

Biloine W. Young • Mon, August 26th, 2013

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Medicare pays for hospital stays. Medicare also counts how many patients are readmitted within 30 days after the end of their initial hospital stay. If readmissions are above the national average, adjusted for patient mix, Medicare will charge the hospital a penalty.

According to PR Newswire, Medicare will begin charging hospitals $265, 000 for each excess readmission (patients who come back within 30 days) after knee or hip replacement surgery that is above the U.S. average. The article states that half of all hospitals have above-average numbers of Medicare patients who return within 30 days after their joint replacement surgery.

Hospitals already pay $35, 000 to $55, 000 penalties for any readmission above the U.S. average for heart attacks, heart failure and pneumonia. The PR writer suggests that hospitals can reduce the possibility of readmissions by better care and also by refusing to treat patients who are seniors. In a letter to Medicare in June 2013, the American College of Surgeons warned about “the potential that these hospitals will decrease their care for such patients, thereby creating an access issue.”

The watchdog site states that hospitals will start paying in October 2014, based on knee and hip replacements installed since July, 2010. The amounts of the penalties are expected to be officially published in the Federal Register later in August.

Penalties are the initial payment times "1/ national readmission rate" The national readmission rate for knee and hip replacements is 5.7%; one over it is 18. This factor times the average initial Medicare payment of $15, 000, is $265, 000.

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One Response to “Joint Replacement Readmission Penalty $265, 000”

  1. Gary says:

    What happened to statistic…outlier average plus/minus 2 SD?

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