While the threat of reduced Medicare reimbursements for hospitals with high rates of readmissions under the Affordable Care Act already has produced results, new research calls on the Centers for Medicare & Medicaid Services to rethink how it determines readmission penalties.
For patients with pneumonia, one of the three conditions included in CMS' hospital readmissions reduction program, the risk of readmission increases after healthcare-associated pneumonia (HCAP) versus community-acquired pneumonia, according to a study published in Clinical Infectious Diseases.
Researchers looked at 771 patients who survived to discharge and found those with HCAP were 7.5 times more likely return to the hospital.
HCAP patients also had a 24.4 percent readmission rate, compared to 4.1 percent for community-acquired pneumonia, according to Infectious Disease News.
Factors including admission from long-term care, immunosuppression, prior antibiotics and prior hospitalization were associated with readmission among HCAP patients.
Because variables associated with readmission are outside of hospitals' direct control, it's "inappropriate" to use one payment rule that doesn't consider HCAP and its criteria, according to the researchers.
"At present, CMS fails to distinguish between community-acquired and healthcare-associated pneumonia in its efforts to decline payment for readmissions," Andrew Shorr, M.D., associate section director of pulmonary critical care at the Washington Hospital Center, told Infectious Disease News. "This is clearly myopic and penalizes physicians and hospitals inappropriately without addressing the key issues," he said.