Re-admissions penalty doing little to slow the spinning of hospitals’ revolving doors

Author of original content: Jeff Lagasse
Original article found here.

Every American hospital has two front doors: The real one, and an imaginary revolving door. Any patient who winds up back in the hospital within a few weeks of getting out travels through that imaginary door, and the more of them there are, the more money the hospital stands to lose from the Medicare system.

This readmission penalty aims to spur hospitals to prevent unnecessary costly care, but a new study shows that after several years of rapid improvements in re-admissions, the readmission penalty program may be spinning its wheels more than it’s slowing the spinning of the revolving hospital door.

Writing in the journal Health Affairs, a team from the University of Michigan reported findings from their analysis of data from nearly 2.5 million Medicare patients. They focused on those who had hip or knee replacement surgery before and after penalties affecting these operations were announced.

The study shows the readmission rate for these patients had already started dropping by the time the idea of readmission penalties was announced as part of the Affordable Care Act in 2010. Soon after that, the re-admissions rate for these surgical patients started dropping faster — even though the penalties announced in the ACA did not apply to surgical patients.

The rate kept dropping rapidly for several years — even though hospitals weren’t getting penalized yet for hip and knee replacement-related re-admissions. But that improvement started to slow down.

After the government announced in late 2013 that penalties would expand to hip and knee replacement, the rate of re-admissions for these patients kept dropping, but at nearly half the rate. In other words, improvements in surgical re-admissions slowed to the same pace they had before any penalties were announced in 2010.


At the same time the readmission rates were changing, the average cost of caring for a Medicare hip or knee replacement patient did too, the study showed. In fact, it dropped by more than $3,000 from 2008 to 2016.

And hip and knee patients’ chance of heading home from the hospital, rather than to a skilled nursing facility or other setting, has increased over that time. So has the likelihood that they will have assistance from a home health aide when they get home.

The authors contend that the same efforts that hospitals may have launched to prevent readmission of medical patients may have extended to these surgical patients. These might include care coordination programs and phone check-ins with recently discharged patients, or better patient education about home care or changes to their medications.

The Hospital Readmission Reduction Program, or HRRP, still carries large penalties — up to 3% of what a hospital earns for certain Medicare patients. It has also expanded to include more conditions, including heart bypass surgery and more types of pneumonia, including those with sepsis.

But researchers say that adding more conditions to the program is not likely to result in much more readmission prevention or cost savings.

In the end, some re-admissions are inevitable, they said, and trying to drive rates lower through penalties may mean some patients who should have been readmitted won’t be.

Instead, the authors suggest that more use of bundled payments — where Medicare sets a defined amount of money it will pay for the episode of care surrounding a surgical patient’s operation — could produce better results. This is because bundled payments ensure hospitals focus on costs and complications around the entire episode of care, not just one metric like re-admissions.


There’s been ongoing debate regarding the equity of the HRRP. For example, safety net hospitals have long held they are unfairly penalized for their readmission rates under HRRP’s current performance model because it doesn’t account for social risk factors that put these patients at risk for readmission.

Medicare Part B Fairness Act Introduced

Representatives Katie Hill (D-CA-25) and Brian Babin (R-TX-36) recently introduced The Medicare Part B Fairness Act (H.R. 1788). The bill would limit the amount and duration of the Part B Late Enrollment Penalty (LEP). As well as expand the Special Enrollment Period for people with employer-sponsored coverage to other types of pre-Medicare coverage.

To amend title XVIII of the Social Security Act to limit the penalty for late enrollment under part B of the Medicare Program to 15 percent and twice the period of no enrollment, and to exclude periods of COBRA, retiree, and VA coverage from such late enrollment penalty.

Bills Introduced to Protect Medicare Beneficiaries from Observation Status Coverage Gap

Last week, bipartisan, bicameral legislation was introduced to ensure all Medicare beneficiaries who spend three days or more in a hospital can access post-acute care in a Skilled Nursing Facility (SNF) when they need it. Currently, Medicare can deny SNF coverage following a hospital stay classified as outpatient observation rather than inpatient. The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682S.753) would protect beneficiaries from surprise bills for skilled nursing care by counting time they spend in observation status toward Medicare’s three-day stay requirement. Are you hospital inpatient or outpatient?

Click here to see the PDF

How to find and compare hospitals

When you’re comparing hospitals, look for one that:

  • Has the best experience with your condition.
  • Participates in Medicare and is covered by your health plan.
  • Checks and improves the quality of its care.
  • Performs well on quality measures, including a national patient survey.
  • Meets your needs in terms of location.

Click link – View Medicare Website


Learn About Medicare Parts A, B, C & D

Join us at Louis Bay public library in Hawthorne, NJ. Bring your questions and thoughts. Free event Saturday, March 23rd, starts @ 11 AM.

If you will be entering the Medicare program and would like to use your benefits, it can be over whelming. Deciding when do I apply for Part A, Part B & Part D.

Your choices about your health care coverage is very important and to make an educated decision can be confusing. Come to explore what your options are and get your questions answered.

Medicare 101 Parts ABCD

Confused About Medicare?

Call us , we will be able to help you learn & understand the basics of Medicare, compare Medicare plans,  and how it coordinates with other coverage. New to Medicare

If you have enrolled with Medicare already and beginning to receive information about the changes of your current plan, call us to discuss next year’s options.

We can also review your options  and choose  the right plan for you. If you are just starting your Medicare now or looking into a future date.

We can sit down for further discussion, call for an appointment, Now! 201-644-8502

Ten Things to Know About Your New Medicare Card

10 things to know about your new Medicare card
Medicare is mailing new Medicare cards started in April 2018. Here are 10 things to know about
your new Medicare card:

1. Mailing takes time: Your card may arrive at
a different time than your friend’s or neighbor’s.

2. Destroy your old Medicare card: Once you get your new Medicare card, destroy your old Medicare
card and start using your new card right away.

3. Guard your card: Only give your new Medicare Number to doctors, pharmacists, other health care
providers, your insurers, or people you trust to work with Medicare on your behalf.

4. Your Medicare Number is unique: Your card has a new number instead of your Social Security
Number. This new number is unique to you.

5. Your new card is paper: Paper cards are easier for many providers to use and copy, and they save
taxpayers a lot of money. Plus, you can print your own replacement card if you need one!

6. Keep your new card with you: Carry your new card and show it to your health care providers when
you need care.

7. Your doctor knows it’s coming: Doctors,
other health care facilities and providers will ask for your new Medicare card when you need care.

8. You can find your number: If you forget your new card, you, your doctor or other health care
provider may be able to look up your Medicare Number online.

9. Keep your Medicare Advantage Card: If you’re in a Medicare Advantage Plan (like an HMO or PPO),
your Medicare Advantage
Plan ID card is your main card for Medicare – you should still keep and use it whenever you need
care. However, you also may be asked to show your new Medicare card, so you should carry this card

10. Help is available: If you don’t get your new Medicare card by April 2019, call 1-800-MEDICARE
(1-800-633-4227). TTY users can call 1-877-486-2048.
You have the right to get Medicare information in an accessible format, like large print, Braille,
or audio. You also have the right to file a complaint if you feel you’ve been discriminated
against. Visit cmsnondiscriminationnotice.html,
or call 1-800-MEDICARE (1-800-633-4227) for more

All people with Medicare are getting new Medicare cards. These new cards have a new Medicare Number that’s unique to each person with Medicare, instead of their Social Security Number.

When should I get it?

Medicare has started mailing cards to certain states and will continue mailing nationwide. Your new card will automatically come to you. You don’t need to do anything as long as your address is up to date. If you need to update your address, visit your mySocial Security account.

Sign up to get an email when your card mails.

Who sends it?


What should I do when I get this card?

  • Destroy your old Medicare card and start using your new card right away. Your Medicare coverage and benefits stay the same.
  • Keep using your Medicare Advantage Plan ID card if you’re in a Medicare Advantage Plan, like an HMO or PPO.
  • Carry your new Medicare card with you. Doctors, other health care providers, and facilities know it’s coming and will ask you for it.

Download a sample letter

New Medicare Card letter [PDF, 793 KB]

Ways to Avoid Part D Late Enrollment Penalty

  1. Join a Medicare drug plan when you’re first eligible.You won’t have to pay a penalty, even if you’ve never had prescription drug coverage before.
  2. Don’t go 63 days or more in a row without a Medicare drug plan or other creditable drug coverage.Creditable prescription drug coverage could include drug coverage from a current or former employer or unionTRICAREIndian Health Service, the Department of Veterans Affairs, or health insurance coverage. Your plan must tell you each year if your drug coverage is creditable coverage. They may send you this information in a letter, or draw your attention to it in a newsletter or other piece of correspondence. Keep this information because you may need it if you join a Medicare drug plan later.
  3. Tell your plan about any drug coverage you had if they ask about it.When you join a Medicare drug plan, the plan will check to see if you had creditable drug coverage for 63 days or more in a row. If the plan believes you didn’t, it will send you a letter with a form asking about any drug coverage you had. Complete the form and return it to your drug plan by the deadline in the letter. If you don’t tell the plan about your creditable drug coverage, you may have to pay a penalty.

View Medicare Website

Transition to Medicare

by Cheryl McCarthy

The transition from group health benefits to Medicare is important but confusing. Currently, Medicare and Social Security are involved in determining what individuals will pay toward the cost of their Part B coverage. This confuses individuals not only on what they are told but on the timing on when information is sent to them. Nationally, more than 750,000 members are paying late enrollment penalties (LEP) and these penalties remain in place for as long as they are paying for Part B. As Medicare health plan advisors, we can help prevent costly enrollment mistakes when we facilitate a smooth transition into Medicare. It’s time to get educated! 

Many eligible members continue to work into their Medicare years until they are eligible for full Social Security benefits, currently at age 66. For this reason, group health advisors have the advantage of being the first respected and relevant influencer for a smooth transition to Medicare. 

We can help our clients make an informed decision about when to enroll in Medicare. Knowing when a member can and should enroll in Medicare A and B is just as significant as knowing when a member can and should enroll in an individual Medicare benefit as a stand-alone product. It is equally important to understand the Medicare Secondary Payer Laws. Who pays first — Medicare or the employer group health plan? There are many ways that we can facilitate a smooth transition into Medicare.

Call us NOW!

View Medicare Website

Medicare 101 Seminar – Hawthorne, NJ

Come learn a little bit more of your ABCDs of Medicare. Meeting at the Hawthorne Library Sept. 29, 2018 @ 2 pm

Is this a topic that gets confusing? Come get some clarification. Turning 65 and you are not sure if you should keep your employer plan or not. Are you getting ready to retire and you are over age 65. Come find out how to avoid penalties. Bring your questions.

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