A longtime source of reimbursement for hospitals and post-acute providers may be significantly reduced, providing yet another reason to beef up efforts to trim readmissions. The Centers for Medicare & Medicaid Services (CMS) is seeking public comment on a proposed rule
that would cut an estimated $6.9 billion in Medicare spending by scaling back allowable bad-debt reimbursement to 65 percent for all providers.
Since allowable bad debt, according to CMS, is based on co-payments and deductibles for services that Medicare beneficiaries are unable to pay, the fewer patient transitions requiring more co-pays and deductibles, the better. Unnecessary admissions or preventable readmissions may trigger bad debt that would no longer be reimbursable.
If implemented, the rule would take effect sometime in 2013. CMS is accepting comments on it through the end of this month.
Whatever CMS decides, the underlying issue is undeniable: Bad patient placements drive up patient costs by triggering transitions to other levels of care. To reduce the number of those transitions and related costs, hospitals should:
- Increase awareness. Ensure that staff members appreciate the cost of services and the impact on patients and the facility. Hospitals that serve a high Medicare population with low-income patients are at especially high risk for bad debt. Education and accountability are critical to staying in business.
- Make better placements. Discharge planning requires careful attention to meeting patient needs. A poor decision about the next level of care leads to a poor outcome that may include a return to the hospital, again driving up costs. Use patient-transition technology to free up clinicians’ time for patient care and to identify more placement options likely to lead to better outcomes.
- Determine correct status. Inpatient status requires a more expensive co-pay than observation, so make sure that staff accurately determines the appropriateness of admission. Consider an in service on the subject.
Jackie Birmingham, RN, MS, is vice president, emeritus, of clinical leadership at Curaspan Health Group. This article reprinted with permission. View the original article on the Curaspan website.