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Part II Nutrition Assessment, Consequences, and Implications Figure 20.1 Patient Protection and Affordable Care Act Key Dates and Events 2008

• Hospital-acquired conditions (HACs): October 1, 2008: Medicare selected 11 conditions in which hospitals do not receive higher payment during hospitalization (Medicaid followed in 2011)

2009 2010

• Hospital-acquired infections (HAIs): Medicare selected certain HAIs in which hospitals do not receive higher payment during hospitalization

• March 23, 2010: PPACA signed into law 2012

• Hospital-acquired infections (HAIs): Medicare will increase payments for reduction in HAIs

• October 1, 2012: CMS began the Hospital Readmissions Reduction Program (HRRP) to reduce payments to hospitals with excess readmissions for CHF, AMI, and PNA

2013 • Readmissions: Medicare payment reduced for high readmission rates by 1% 2014

• Readmissions: Medicare payment reduced for high readmission rates by 2% • Medicare to cut payments for certain HACs by 1%

• October 1, 2014: CMS to reduce payments to hospitals with excess readmissions for COPD, THA, and TKA

2015

• Readmissions: Medicare payment reduced for high readmission rates by 3% • January 1, 2015: CMS begins using the Medicare fee schedule to give larger

payments to physicians who provide high-quality care compared with cost

Source: Data are from US Department of Health & Human Services. Key features of the Afordable Care Act. www.hhs .gov/healthcare/facts/timeline/index.html. Accessed August 1, 2014.

To date, many hospitals have been penalized for high readmission rates, resulting in millions of dollars in reduced payments. A 2013 report from the Health Industry Distributors Association (HIDA) showed that in 2013, more than 2,000 hospitals were penalized by CMS, resulting in an estimated $280 million in reduc- tion in payments (8).

Hospital readmissions are also common for older adults in other care settings outside of the hospital. In 2010, 12% of those discharged from inpatient rehabili- tation facilities to the community were readmitted to acute care hospitals within 30 days (9). Furthermore, a 2014 study of 30 day readmission rates in Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation facilities to the community showed that the overall 30 day readmission rate was 11.8% and ranged from 5.8% for those with lower extremity joint replacement to 18.8% for those with debility.

Approx imately 50% of individuals readmitted within the 30-day period were readmitted within 11 days of discharge; common reasons for readmission included CHF, urinary tract infection, PNA, septicemia, and nutritional and metabolic disorders (10). Additionally, the government has begun tracking hospital readmis- sions in these care settings with the Medicare Payment Advisory Commission (MedPAC), and CMS recently identified 30-day readmission as a national quality indicator for inpatient rehabilitation facilities (11). Hospital readmissions are common, are expensive, and may result in significant complications for skilled nursing facility (SNF) and long-term care (LTC) resi- dents as well. Research shows that one in four (23.5%) residents admitted to a skilled nursing facility are read- mitted to the hospital within 30 days at a cost of $4.3 billion for total Medicare reimbursement (12). Similar to hospital readmissions, research concludes that many