案例库 · 财务与会计 · 财务决策 · 2012
这条还没译成中文，下面是英文原文。
Medicare docks up to 3% from hospitals with too many readmissions.
The 2012 HRRP cuts up to 3% of Medicare inpatient pay from hospitals with excess 30-day readmissions, making hospitals own the whole episode.
U.S. Centers for Medicare & Medicaid Services · U.S. hospitals
那一手
Medicare paid hospitals for every admission, so a patient readmitted soon after discharge generated a second, full payment, and hospitals had little reason to stop it.
The 2012 HRRP computes a hospital's risk-adjusted 30-day readmission rate for specified conditions and reduces its Medicare inpatient payments by up to 3% when that rate is better than expected.
The penalty shifts money from an outcome to a payment, so hospitals invest in discharge planning, follow-up and coordinated care rather than just filling beds.
为什么管用
- The readmission penalty makes the payer's money follow the episode, not the bed-day
- Up to 3% is large enough to change hospital behaviour
- It targets an outcome, not just a process measure
- It transfers risk from the payer to the provider
可以搬走什么
If a payer rewards volume and not an outcome, add a penalty on the bad outcome — a modest price on readmission moves behaviour more than any quality campaign.
后来呢
Hospitals responded with transitional care and better discharge coordination, and readmission rates for the targeted conditions fell, though critics warned the penalty could penalize safety-net hospitals serving sicker patients and that it shifted care without improving it everywhere.
资料来源
- Medicare in the 21st Century: Understanding the Hospital Readmissions Reduction Program
- Hospitals with the highest readmission penalties
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