Hospitals with the highest readmission penalties

Which hospitals have the highest readmission rate penalties?

For fiscal year 2021, 39 hospitals received the highest readmission rate penalty – their Medicare revenue will decrease by 3% based on their readmission rates. Of these hospitals, CHRISTUS Good Shepherd Medical Center – Marshall, is the largest based on its nearly 17,000 annual discharges.

Seven hospitals on the list are in Texas and five are in both Massachusetts and Kentucky. They average 4,287 discharges a year.

Numerous factors affect a hospital’s readmission rate, and therefore their readmission penalties, including the health of the patient population and the severity of their conditions during their hospital stay.

How much do hospitals get penalized for readmissions?

On average, the 2,985 hospitals that participate in HRRP are penalized by 0.59% of their Medicare revenue, or about a $178,000 loss each in 2021.

How is the CMS readmission rate penalty calculated?

HRRP reduces payments to Inpatient Prospective Payment System (IPPS) hospitals with excess readmissions as compared to the national average for the applicable condition.

The Medicare readmission rate penalty is a ratio based on payments made for excess readmissions out of all payments for discharges. A negative ratio indicates a decrease in reimbursement by that percentage amount, up to 3%.

What is a hospital readmission?

Readmissions are defined as admissions to an acute care hospital within 30 days of discharge to any subsection (i.e. department) of that entity for any condition or diagnosis.

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