Hospital Outcomes Act of 2016

Hospital Outcomes Act of 2016

This bill amends title XVIII (Medicare) of the Social Security Act to replace the existing methodology for calculating Medicare payment adjustments for subsection (d) hospitals based on outcomes in readmissions and complications with a new methodology based on potentially avoidable outcomes in those areas. (In general, a "subsection (d) hospital" is an acute care hospital that receives payments under Medicare's inpatient prospective payment system.)

The bill: (1) establishes a methodology for determining a hospital's financial impact attributable to potentially avoidable outcomes performance with regard to complications and readmissions, and (2) requires the Centers for Medicare & Medicaid Services (CMS) to select methodologies for identifying potentially avoidable outcomes in these categories. Subject to both a ceiling and a floor, a hospital's payment adjustment factor for an applicable prospective period shall be based on the ratio of the hospital's financial impact to the aggregate amount of standardized payments made to the hospital with respect to that period.

CMS must ensure budget neutrality with respect to application of the payment adjustment factor across all subsection (d) hospitals.

CMS shall regularly report to hospitals and to the public on each hospital's performance with regard to potentially avoidable outcomes.