The North Carolina Hospital Association (NCHA), based in Cary, N.C., announced a partnership with Forecast Health, a Durham-based data analytics company, to provide hospitals in the state with predictive data about their readmissions rates and whether they are at risk of penalties by the Center for Medicare and Medicaid Services (CMS).
Under the Hospital Readmission Reductions Program (HRRP) established in the Affordable Care Act (ACA, hospitals are subject to penalties if their readmissions rates exceed benchmarks set by CMS. According to NCHA, hospitals are notified by the agency whether they will be penalized when it is too late for to act to prevent it. The penalties, which CMS imposes by reducing reimbursements in the following year, can have a severe financial impact on hospital funding, according to NCHA. In 2017, more than 2,500 hospitals nationwide will be penalized more than half a billion dollars, the association stated.
Predicting HRRP penalties is the first of a three phase program to deliver advanced readmissions data to provider organizations in North Carolina. In the next two phases, NCHA and Forecast Health will estimate penalties for hospitals under CMS’ 30-Day All Cause Readmissions Program, a complex quality measure impacting solo practitioners and groups and use social determinants of health data to measure readmissions that are a result of quality of care, and not socioeconomic or lifestyle factors.
Hugh Tilson,Interim President of the NCHA, said in a prepared statement, “Working with Forecast Health, we have improved the accuracy of our readmissions rate predictions across all measures by more than 34 percent. This information will help our member hospitals better manage care for high risk patients and improve the overall health of the communities they serve.”
“Today, too many hospitals are left guessing whether they are going to be hit with CMS penalties and what they can do about it,” Norm Storwick, FSA MAAA, Forecast Health’s chief actuary and director of product management, said in a statement. “It doesn’t need to be this way. Working together, Forecast Health and NCHA enable NCHA members to understand how CMS measures their readmission rates as well as their actual and risk adjusted rates so they avoid penalties and improve clinical and financial performance."
