In October each year we enjoy the State Fair of Texas, fall festivals, carving pumpkins and Texas football at all levels. This year a new event begins Oct. 1, 2012 resulting from the Patient Protection and Affordable Care Act (ACA). A readmissions provision imposes financial penalties on hospitals for “excess” readmissions when compared to “expected” levels of readmission. Generally, hospitals will be tagged for Medicare readmissions occurring within 30 days of discharge, which may sound reasonable to the general public. Hospitals support appropriate value-based purchasing and the ACA as signed into law by President Obama on March 23, 2010. However, some provisions such as the readmission penalty need to be modified and fairly implemented.

There needs to be a distinction between related and unrelated admissions as well as planned and unplanned readmissions. For example, some patients receiving chemotherapy have scheduled readmissions within 30 days. Therefore, planned readmissions may be clinically appropriate for therapeutic purposes. There is also compelling evidence that hospitals serving large numbers of low-income individuals will have difficulty reducing readmissions due to lack of resources (primary care providers and pharmacies) in the communities where they reside.  Also, patients must follow discharge instructions such as taking prescribed medications, eating the proper diet, not smoking, keeping follow-up appointments, etc., especially with congestive heart failure, heart attack and pneumonia.

The Centers for Medicare and Medicaid Services (CMS) must revise, refine and modify some of the problems in the readmission measures so penalties are administered in an equitable manner. We all want to prevent unnecessary readmissions, but realize these are complex issues. We need to exercise appropriate judgment because many factors are beyond the hospital’s control.