Hospital Readmission Prevention is a Must as CMS Fines Half of Hospitals


The US healthcare system is in an unfortunate state – it just can’t seem to catch a break. While it was already coping with a number of issues – such as medical identity theft, the lack of price transparency, interoperability issues, and healthcare data breaches, among others – COVID-19 hit it hard. As a result, healthcare providers across the US are facing huge losses. With increasing COVID-19 cases across the States and with experts predicting even more during the fall, healthcare providers received yet another blow. CMS (Centers for Medicare & Medicaid Services) will fine about half of hospitals due to readmissions of Medicare patients, although this is for the pre-pandemic period and therefore COVID-19 cannot be held accountable for the lower payments. Let’s take a look at the numbers, how this will affect the hospitals further, and how hospital readmission prevention can be achieved with a proper patient identity verification platform.


CMS will lower payments

While it’s already been quite a harsh year for healthcare providers, it’s about to get worse. Many caregivers are resorting to cost-cutting strategies by laying off employees, furloughing them, or even shutting down; however, the lowered payments will only add to the unprecedented costs.

Some numbers surrounding the penalties

During the fiscal year 2021, CMS will fine 2,545 hospitals due to increased Medicare patient readmissions that occurred within 30 days. The penalties were based on patient data ranging from July 2016 through June 2019. A staggering 83% of the hospitals received penalties, and they will be facing payment cuts as high as 3% per Medicare case during 2021. 39 caregivers will face the maximum penalty next year, which is an improvement over this year, when the number of hospitals hit with the maximum penalty was 56. However, with the pandemic disrupting everything, hospitals will lose more than ever. As a result, hospital readmission prevention becomes a topmost priority.

Why is the program important?

This is the ninth year of the Hospital Readmissions Reductions Program, and it has been created to improve patient care quality while lowering overall costs. As previously mentioned, it takes into account the readmissions of Medicare patients that occur within 30 days. While CMS is considering a suspension of the penalty program due to COVID-19, the penalties are still in effect this year.


Some exceptions

Congress has exempted 2,176 hospitals out of the 5,267 from penalties due to a number of reasons. The hospitals exempted are either:

  • Critical access hospitals,
  • The only inpatient facility in the area,
  • Hospitals specializing in long-term care, children, veterans, or psychiatric patients.

What the industry thinks about hospital readmission prevention

While many participants within the US healthcare system have voiced disapproval regarding the penalty program, others have said that, while not perfect, the Hospital Readmissions Reductions Program is useful – it pushes caregivers to find innovative solutions to provide better quality care. 

The penalties will further increase hospital losses

Moreover, as healthcare providers are already facing huge losses due to the pandemic, they need to ensure hospital readmission prevention if they want to survive in the long run. Several hospitals are heavily relying on CMS reimbursements, and if they can reduce readmissions, it might help them survive the pandemic’s financial strain. By improving patient safety and quality of care, hospitals can significantly lower readmissions. Fortunately, RightPatient can help with that.

RightPatient enhances hospital readmission prevention

RightPatient has been helping leading healthcare providers with its touchless patient identification platform for years. It ensures improved healthcare outcomes by eliminating one of the most overlooked problems within hospitals: patient misidentification.

Patient misidentification leads to duplicate medical records and overlays, jeopardizing patient safety. Moreover, it provides the wrong medical records to caregivers, resulting in negative healthcare outcomes. Naturally, these are the patients who are readmitted within hospitals frequently. So, how does RightPatient help?

It locks the medical records of the patients using their photos during registration. Patients receive an SMS/email after they schedule appointments, and they are required to provide a personal photo and a photo of their driver’s license. RightPatient compares the photos for a proper match, eliminating any chance of misidentifications. All of this is done without requiring the patients to touch any foreign objects, eliminating infection control issues – something that is crucial during and after the pandemic.

Reduce patient readmissions, improve healthcare outcomes, and ensure patient safety with RightPatient – contact us now to learn how we can help you.


2583 hospitals hit with penalties due to readmission reduction program


Medicare hit 2583 health systems with penalties by cutting payments to them. This has been happening for the last eight years and thanks to the ACA, it is an effort to reduce the readmission rates of hospitals. This specifically focuses on the patients who return within the same month after they are primarily discharged which helps the readmission reduction program.

This is not something new, as it is a recurrent theme for the last few years, where Medicare predicts that it’ll cost the hospitals a whopping $563 million per year. This effort to reduce readmissions is known as the Hospital Readmission Reduction Program and has about 3129 hospitals attached to it. Out of them, a staggering 83% could not reduce the readmission rate and thus, were slapped with the penalties. This penalty to each of these hospitals will be in the form of deductions from the payments Medicare will pay them for future patients over the next year, starting this October 1st.


One thing has been repeatedly said that these efforts have been going on for quite some time, since 2012, to be precise. However, many are still unclear whether these fines are helping to reduce readmission rates and thus generating better patient safety. On the other hand, these efforts have been reinforcing hospitals and health systems to reimagine how the patients are receiving care and focus on their health after discharging them so that minimal readmissions occur. Conversely, many industry pundits have chimed in that a few healthcare providers may intentionally avoid readmitting patients who require critical post-discharge healthcare services solely because of these penalties, which is severely detrimental for the patient’s health as well the hospitals’ reputations. Others are saying the program itself is not that effective, although it has brought in small benefits. 

Some studies were conducted, and it was revealed that this HRRP caused an increase in fatal incidents regarding patients. However, it was refuted by a study conducted by the Medicare Payment Advisory Commission (MedPAC).

Sometime last month, MedPAC’s study was released to the public, and it showed that the number of readmissions of Medicare patients within a timeframe of 30 days decreased to 15.7% in 2017 from 16.7% in 2010. 

Going into specifics, the hospitals are penalized for these readmissions when the patients are provided with healthcare services for heart failure, pneumonia, heart attack, hip and knee replacement, chronic coronary artery bypass graft surgery, or lung disease. One good thing regarding HRRP is that inevitable readmissions, for instance, scheduled ones, are exempted from penalties. Delving deeper, HRRP dictates that if patients return within the 30 days timeframe, the hospital will be penalized. Also, if the Medicare-funded patients go to a different hospital, the primary hospital which provided the care will be penalized. 

According to KHN, about 1177 hospitals were penalized higher than they were compared to last year, whereas 1148 received lower penalties compared to the previous period. 64 providers were stable since they received the same amount of penalty compared to last year. 194 new hospitals were added to the list of penalized hospitals, whereas 372 exemplary hospitals received no penalties for two consecutive years. However, one thing must be noted – 2142 health systems and hospitals were exempted due to the lower number of cases, veterans, or children’s hospitals. 

So, the readmission reduction program is one of the biggest headaches of hospitals and health systems. How can they be reduced? Well, a lot of health systems are using RightPatient to address it. It is a biometric patient identification platform that locks the medical records of the patents with their biometric data and the records cannot be accessed without biometrics. Other than ensuring positive patient identification, it also ensures that the hospitals receive a notification when a patient enters their premises within the 30-day period so that they can be provided with better care and thus ensuring better patient experience, reducing the penalties as well as better patient outcomes and thus, minimizing losses while creating a win-win situation for all.