Readmission Penalty Relation to Volumes

Five condition-specific maladies are used to calculate the readmission penalty for a hospital during Federal Fiscal Year (FFY) 2016. They 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 is a payment reduction of $ 420 million. For Virginia, the penalty is expected to exceed $21 million. As last week’s Research Corner noted, approximately $ 12 million (or 57 percent) of the readmission penalty for Virginia is associated with the total hip and knee condition code. This week’s examination focused on the total number of discharges by each condition and found that total hip and knee replacements accounted for 22.5 percent of the discharges by condition. The leading condition is heart failure at 27.2 percent of discharges across Virginia hospitals. The graph below illustrates estimated penalties by dollar amount, and percentage of eligible discharges for FFY 2016. (December 11)