Hospitals are reexamining their best practices in the wake of last week’s release of penalty data from the CMS Hospital Readmissions Reduction Program.  

Of more than 300 California hospitals, approximately 65 percent were sanctioned. Overall, Southern California facilities’ penalty rate was down slightly over last year. While the HRRP allows a maximum penalty of 3 percent of a hospital’s annual reimbursement, no Southern California hospitals got socked for the full amount.

Since the penalty system debuted in 2012, hospitals have established procedures to limit readmissions. Practices that have borne fruit have been picked up by other facilities. Some of the procedures include more detailed post-discharge planning for patients, including help obtaining medications and guidelines for homecare workers and families on specific patient needs.

While the penalty rate is subsiding, many hospital administrators maintain that factors outside of their control prompt some patients to reappear within the one-month window monitored by the program. Specifically, patients from lower-income households have higher rates of readmission, they note.

Patients from less-affluent communities also face bigger hurdles in obtaining prescriptions and making it to their next appointment, they add. The result is that hospitals located in these communities are unfairly penalized by the system, industry advocates point out.

Marty Gallegos, HASC’s chief policy expert, has been following the issue since it emerged.

“The current methodologies that are used don’t recognize factors that are outside of the hospital’s control,” he said last week.

To correct that imbalance, HASC and the California Hospital Association are supporting H.R. 1343, federal legislation that would add socioeconomic factors to the system. Hospitals across the country fall under the existing system.

Other strategies hospitals are implementing include coordinating with nursing-home staff, educating family members about patients’ needs and involving community-based organizations in care plans. Often, simply arranging prescription-refill deliveries can help discharged patients recover without returning to the hospital, many have learned.