Medicare’s Pay for Performance Effort Begins, Doctors and Hospitals Fear

Denied Reimbursement for Hospital Readmissions within 30 days of Discharge

WASHINGTON – Congresswoman Renee Ellmers released the following statement from her office in Washington this afternoon:

"We are now officially in a new era of healthcare insolvency. The new mandates that went into effect yesterday will begin penalizing doctors, hospitals, and their patients for hospital care that does not fit into a pre-ordained framework and schedule designed by the federal government. Penalties are set to begin going out to over 2,200 hospitals across the country, forcing doctors to make decisions that are based on financial penalties, not the best interest of their patients."

"The Department of Health and Human Services is implying that hospitals can control whether or not a patient relapses. But this fails to take into consideration elderly and chronic patients with unforeseen complications and checkups. There is no question that doctors will readmit their patients when care is needed. They will not be turned away and hospitals will try to come up with other ways to offset the penalties. No matter how you look at it, these mandates will result in a decreased quality of care. This is exactly why I supported the full repeal of Obamacare and why we need to fight for patient centered solutions."

Fox News reported in August that the "pay for performance" provision of ObamaCare is set to punish roughly two-thirds of U.S. hospitals evaluated by Medicare starting this fall over high readmission rates, according to an analysis by Kaiser Health News (KHN). The provision went into effect yesterday:

[The provision] directs Medicare to reduce reimbursements to hospitals with high 30-day readmission rates -- which refers to patients who return within a month -- by as much as 1 percent. The maximum penalty increases to 2 percent the following year and 3 percent in 2014. They go on to note that "doctors are concerned the penalty is unfair, since sometimes they have to accept patients more than once in a brief period of time but could be penalized for doing so -- even for accepting seniors who are sick."

Medicare evaluated readmission rates at 3,367 of the nation's hospitals and will impose penalties on 2,211 starting in October, according to KHN. The analysis shows 278 hospitals will receive this year's maximum penalty of 1 percent. On the other side of the spectrum, 50 hospitals will receive the minimum penalty of 0.01 percent.

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