The Illinois Department of Healthcare and Family Services www.hfs.illinois.gov (HFS) is going to collect $16.3 million in penalties from 82 state hospitals in an effort to lower the number of Potentially Preventable Readmissions (PPR).
HFS has already recouped $5.6 million in penalties through hospital payment reductions. According to HFS Director Julie Hamos, “Negotiations were conducted more than a year ago and the hospitals in question had a year to make improvements to avoid these costs.”
The PPR policy requires hospitals to review their discharge planning and post-discharge care to ensure that patients aren’t being discharged too quickly while still sick or receive poor follow-up care. Hospitals with unacceptable PPR rates face penalties from the state that equal the cost of the excess readmissions.
The department used 3M’s PPR 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 can vary among the populations served by each hospital.
State officials have determined that 147 hospitals had unacceptable PPR levels and thus owed the state under the policy. Of the 147 hospitals, 65 were able to enact measures that lowered their PPR levels significantly and enabled them to avoid paying the $18.5 million owed.