HFS to collect $16.3 million from
Illinois hospitals to reduce potentially preventable readmissions
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[September 12, 2014]
Illinois Department of Healthcare and Family Services announced Friday,
Sept. 5, it will begin collecting $16.3 million in penalties from 82
Illinois hospitals in an effort to lower the number of potentially
preventable readmissions (PPR) and keep patients healthier.
The PPR policy is a healthcare quality initiative designed to
encourage providers to reduce inpatient hospital readmissions that
could be prevented. It requires hospitals to review their discharge
planning and post-discharge care to ensure patients aren’t being
discharged too quickly, while still sick or with poor follow-up
care. Hospitals with unacceptable PPR rates face penalties from the
state that equal the cost of the excess readmissions.
The department has already recouped $5.6 million in penalties
through hospital payment reductions.
“This was negotiated more than a year ago, and the hospitals in
question had a year to make improvements to avoid these costs,” said
HFS Director Julie Hamos. “Not all readmissions can be prevented,
but Illinois hospitals can do better. We hope that this initiative
will encourage providers to reduce their potentially preventable
readmissions so that Medicaid clients get and stay healthier and the
state sees lower costs.”
The initiative – similar to a federal program which fines hospitals
that readmit Medicare patients for preventable causes – stems from
HFS’ study of Illinois hospitals’ FY 2010 inpatient claims data and
trending analysis for 2009, 2010 and part of 2011. The department
used 3M’s Potentially Preventable Readmission software to calculate
a readmission rate for each hospital, comparing patients’ severity
of illness levels at each facility to statewide target levels. Risk
adjustments were made to include patients’ case mix, age and
behavioral health diagnoses, which vary among the populations served
by each hospital.
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State officials determined that 147 hospitals had
unacceptable PPR levels and thus owed the state under the
policy. Of those 147 hospitals, 65 were able to enact measures
that lowered their PPR levels significantly and allowed them to
avoid paying $18.5 million owed.
Those hospitals that did not lower PPR rates can either pay the
total remaining penalty amount owed or contact the department to
discuss a payment plan.
[Text received; ILLINOIS DEPARTMENT
OF HEALTHCARE AND FAMILY SERVICES]