Readmission Penalties Specific to Conditions in the Year Ahead

Five. That’s the number of condition-specific occurrences used to calculate hospital readmission penalties for federal fiscal year (FFY) 2016. The conditions are AMI (heart attack), heart failure, pneumonia, total hip or knee replacement, and chronic obstructive pulmonary disease (COPD). Nationally, the estimated impact on inpatient payments under this system is a payment reduction of $420 million. For Virginia, the estimated penalty is slightly more than $21 million. A large portion of anticipated Virginia penalties associated with readmissions are expected to be attributable to total hip and knee replacements. Approximately $ 12 million, or 57 percent, of the readmission penalty for Virginia is associated with the total hip and knee condition code. The graph below illustrates the estimated penalty by category, dollar amount, and percentage for FFY 2016. (December 4)