Medicare isn't kidding when it says it wants to reduce hospital readmissions within 30 days of discharge—one of the costliest and most preventable line items in health care spending. The agency has set standards for hospitals that they must either meet or pay penalties for missing. And, it appears, hospitals still aren't getting the message.

Ever since the Hospital Readmission Rate Program (created as part of the Affordable Care Act) took effect four years ago, hospitals have paid big bucks for failing to pay attention to this key indicator of efficiency.

This year, Kaiser Health News reports, nearly 2,600 hospitals were penalized under the law, coughing up $420 million in fines.

Kaiser Health News said the program has had some effect, as the readmission rate has begun to trend downward. Still, 20 percent of Medicare patients released from a hospital stay return within the 30-day window.

The rate of penalized hospitals returning to the list of scofflaws within one year is also high: only 209 of the thousands on the list were new to the penalty phase, Kaiser Health News said.

Those facing heavy fines, doled out in the form of lower payments to hospitals, are most prevalent in Alabama, Connecticut, Florida, Massachusetts, New Jersey, New York, Rhode Island, South Carolina, Virginia and the District of Columbia. The lowest rates of penalized hospitals were found in Idaho, Iowa, Kansas, Montana, Nebraska, North Dakota and South Dakota.

Kaiser Health News analyzed HRRP records to develop its report.

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Hospitals fined $420 million for readmission violations

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