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What Do Hospital Readmission Fees Look Like in 2019?

Readmission Statistics

No one wants a patient readmitted to a hospital unnecessarily. It’s bad for the patient’s health, and it can disrupt their life and finances. For medical entities, our job is to make people better as best we can, not have them walking through a revolving door in and out of the hospital. So there are non-pecuniary reasons to reduce readmissions. However, medicine is a business too, and hefty readmission penalties aren’t something to be ignored.

In fact, over the year ahead hospitals will lose $566 million in the latest round of penalties that will be assessed over the next 12 months because patients ended up back in their facilities. Private insurers are also increasingly heaping on fees for too many readmissions. Overall, 82 percent of hospitals will be assessed some sort of penalty.


The fiscal year 2019 may bring some readmission penalty relief to some hospitals, primarily ones that serve low-income populations. Instead, the fees will be more proportionally spread out among hospitals. One of the most significant changes to readmission fee calculations is a shift to evaluating hospitals among “like hospitals” or “peer-to-peer” readmission evaluating. This helps better account for socioeconomic differences.

Readmission fees will still primarily focus on the following areas:

  • Chronic lung disease
  • Coronary artery bypass graft surgery
  • Heart attacks
  • Heart failure
  • Hip and knee replacements
  • Pneumonia

The readmission fees have been recalibrated, though, to take some of the heat off “safety net” hospitals. According to NPR:

Kaiser Health News analysis of the records: The harshest penalty is 3 percent lower reimbursements for every Medicare patient discharged in the fiscal year 2019. The average penalty — 0.7 percent of each payment — is almost the same as last year, as is the number of hospitals penalized.

Milliman does a superb analysis and break-down of the 2019 changes and how they may impact your bottom line, advising in their conclusions that hospitals should closely monitor changes to HRRP and that institutions need to try to continually find ways to improve care to lower-income patients to reduce the possibility of readmission fees.

However, the new method shifted the burden of those punishments. Hospital readmission penalties against safety-net hospitals will drop by a fourth on average from last year, the analysis found.

According to PatientBond Senior Vice-President of Marketing and Analytics Brent Walker, hospital readmissions is “a very complex issue.” Some legislative fixes are probably in order, he says, but something that medical practices and hospitals can do – immediately – to reduce the risk of patient readmission in 2019 is simply to do a better job with follow-up engagement with the patient.

Moreover, with technology today offering so many ways to do it better, cheaper and faster, there are other options. PatientBond, for instance, uses proprietary psychographic segmentation techniques to figure out the best way to “reach” patients and communicate with them how they are comfortable based on their values, attitudes, personalities and lifestyles and understanding their unique motivations.

In a 2018 PatientBond market research study, 78 percent of Priority Jugglers said they are not very or not at all interested in a readmission reduction program and they are statistically more likely than the other four psychographic segments to feel this way. Why does it make sense? Priority Jugglers don’t have much time and they only like to use the time they have to take care of their family. Since this is part of their values, it’s not surprising that they aren’t motivated to participate in this type of program.

PatientBond offers a customizable communication program designed solely to reduce readmissions and improve patient activation. With PatientBond, the patient is able to have a continual two-way dialogue with their provider; this is imperative in heading off health problems after being discharged.

The problem of “transitional care” is so acute that the Joint Commission pointed to it as a leading cause of readmissions. A Joint Commission study estimated that 80 percent of serious medical errors involve miscommunication during the handoff between medical providers:

Problematic transitions occur from and to virtually every type of healthcare setting, but especially when patients leave the hospital to receive care in another setting or at home.

The Joint Commission also flagged technological and communication hurdles as problems. A robust patient engagement program can mitigate these issues. With such a plan in place, your hospital can avoid being among those being hit with readmission penalties and overall health outcomes can be improved.
To learn more about reducing hospital readmissions through patient engagement, download the PatientBond case study.


How Psychographic Segmentation & Digital Engagement Improve Health Outcomes



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