News / Readmission payment rules to be ‘progressively strengthened’

Commissioners will be required to withhold payment for avoidable emergency readmissions within 14 days of discharge and above a locally agreed threshold from 1 December, the Department of Health has confirmed.

In a move to clarify arrangements for non-payment for emergency readmissions, the Department said the requirement would apply until 31 March 2011.

It would be extended to all patients readmitted within 30 days of discharge from 1 April. The Department said rules on readmissions and payment were being progressively strengthened – from optional non-payment to mandatory; from 14 days to 30 days; and from thresholds to individual patients.

A question-and-answer note on the Department website showed a provision in the revised operating framework for 2010/11 that required commissioners and providers to apply the 2010/11 payment by results guidance, if they were not already doing so, from 1 December.

This allows commissioners to withhold payment for avoidable emergency readmissions within 14 days of discharge above locally agreed readmission thresholds – an option they have held for a number of years.

Some local health economies were planning to allow no payment for readmission within 30 days from 1 December and they could do so if commissioners and providers agreed, the note said.

The Department anticipated that from 1 April 2011 hospitals would not receive further payment for any patient readmitted within 30 days of discharge.

Some services will be excluded, and the Department intends to increase some non-elective tariffs for an appropriate level of unavoidable readmissions.