Hospitals: How a Proposed CMS Rule Would Adjust HRRP Penalties by Proportion of Dual-Eligible Patients

In mid-April, the Centers for Medicare and Medicaid Services (CMS) proposed a rule that would take the first step in enabling a more level playing field for safety-net hospitals under the value-based Hospital Readmissions Reduction Program (HRRP).

Specifically, the rule would require Medicare to consider hospitals’ proportion of dual-eligible patients when calculating penalties under the HRRP, as required under the 21st Century Cures Act. Historically, dual-eligible patients are more expensive for hospitals, skewing readmissions figures for safety-net hospitals and even leading to unfair penalties against them—inhibiting their ability to provide treatment to patients that often need it most. Moreover, hospitals are expensive providers of chronic care for capitation plans designed for the dual-eligible patient population.  There is an opportunity for more effective collaboration and coordination of care.

The rule’s comment period is open until June 13. And while it is likely to go through multiple rounds of fine-tuning before it’s finalized, it stands to impact hospitals’ financial risk management strategies. Hospitals should keep up with how it evolves between now and the proposed FY19 effective date.

To get started, read our new alert, which explains how CMS would define a dual-eligible patient and how it would group hospitals to adjust penalties accordingly, here

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