Disease & Discharge Management – Hospital Readmission & Medicare Penalty

Disease & Discharge Management – Hospital Readmission & Medicare Penalty

Owing to ObamaCare (Affordable Care Act – ACA), it is now pertinent for Hospitals to not only ensure better care but also go out of the way to ensure that the patient do not come back to the Hospital for same treatment within 30 days of discharge. CMS – Medicare / Medicaid calls it paradigm shift from ‘Pay for Service’ to Pay for ‘Outcome’. Under the new federal regulations, hospitals face hefty penalties for readmitting patients they have already treated, on the theory that many readmissions result from poor follow-up care.

Medicare, which monitors hospitals’ compliance with the new rules, says nearly two-thirds of hospitals receiving traditional Medicare payments are expected to pay penalties totaling about $300 million in 2013 because too many of their patients were readmitted within 30 days of discharge. Last month, the agency reported that readmissions had dropped to 17.8 percent by late last year from about 19 percent in 2011.

The penalties, which apply to rates of readmission after hospitalization for heart attacks, pneumonia and heart failure, are now calculated at 1 percent of hospital payments but will increase to 3 percent by 2015. Medicare also expects to expand the targeted readmissions to include more kinds of hospitalizations, like those for chronic lung disease.

How we can help in the ultimate goal is to have these numbers come down?

Our Care Management capabilities address the big challenge of Readmissions for Payers as well as Providers. We deploy best in class technology and analytical tool to address the Disease & Discharge management for our clients. Here is the list of stuff we can do for you.

  • On behalf of Hospitals or Payers, we call patients within 48 hours of discharge to find out how they are feeling
  • We can arrange patients’ follow-up appointments with doctors even before a patient leaves home
  • We will put focused efforts to make sure patients understand what medicines to take at home.
  • We can help patients arrange transportation for follow-up doctor visits
  • We can get safe housing or even find a hot meal, all in an effort to keep them healthy
  • We can design & deploy, as part of Discharge Management for patients, a simple plan of what to do after leaving the hospital

We offer hospitals, health plans, accountable care organizations (ACOs), home health agencies and other customers a money-back guarantee on its program to reduce hospital readmissions for high-risk patients.


Manish Jaiswal




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425 Washington Blvd., Jersey City,
New Jersey 07302, USA

Phone: +1 201.258.4704 / 201.258.4704
Fax: +1 201.604.3480