August 6, 2013

Medicare To Punish 24 State Hospitals For High Readmissions

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Twenty-four of Connecticut’s 31 hospitals will face Medicare penalties in the fiscal year starting in October, in the second round of the federal government’s push to reduce the number of patients readmitted within a month of discharge, new data shows.

None of the state’s hospitals will lose the maximum amount possible – 2 percent of every Medicare payment for a patient stay — which is double this year’s penalty. But three will lose more than 1 percent. The Hospital of St. Raphael, which is now merged with Yale-New Haven Hospital, will lose 1.77 percent; the Masonic Home and Hospital in Wallingford will lose 1.14 percent; and St. Vincent’s Medical Center in Bridgeport will lose 1.06 percent.

Statewide, Connecticut’s hospitals face an average penalty of .43 percent of Medicare funds, which is higher than the national average. Hospitals in 12 states, including Massachusetts and Rhode Island, face higher average penalties.

Hospital administrators in the state say they have made myriad efforts to reduce readmissions in the past two years, and they note that the new penalties are based on readmissions through June 2012. Medicare counts patients who originally went into the hospital with at least one of three conditions — heart attack, heart failure or pneumonia—and landed back in the hospital within 30 days for any reason, even if it was unrelated to the original stay.

Nationally, about 20 percent of hospitalized Medicare patients are back within 30 days, at an estimated cost of $17 billion a year, according to the Medicare Payment Advisory Commission.

At Yale-New Haven Hospital, efforts to reduce readmissions, especially for heart failure patients, have focused largely on improvements in discharge planning, said Dr. Thomas Balcezak, senior vice president of patient safety and quality.

“We’re working on making sure every patient gets a ‘warm handoff’” that includes clear discharge instructions on medication, follow-up appointments and continuing care. Some elderly patients receive help from ‘patient navigators’ in securing proper services after discharge, under a grant program that Yale is piloting.

Yale-New Haven acquired the Hospital of St. Raphael last September, and the two hospitals had different readmission results in 2012. Yale faces a Medicare penalty of .51 percent in the coming year – less than this year’s .90 percent penalty. But St. Raphael’s penalty went up – from the maximum 1 percent last year, to 1.77 percent in the new fiscal year, the highest in the state.

Balcezak said efforts have been underway since the acquisition to merge and align the two hospital’s policies and operations – moves he said may help to reduce readmission rates for both hospitals. Recently, the two campuses adopted one electronic medical records system, so that information can be shared more easily among clinicians.

Hospital experts have noted that so-called safety net hospitals, which treat large numbers of low-income people, tend to have higher readmission rates. Some experts have recommended that the readmission penalties take into account the socio-economic status of patients.

Nationally, 2,225 hospitals will have Medicare payments reduced starting on Oct. 1, according to an analysis by Kaiser Health News.  Eighteen hospitals will lose the maximum 2 percent, while about 150 will lose 1 percent or more.

In Connecticut, seven hospitals will face no penalties. They are: Stamford Hospital, Rockville General, New Milford, Middlesex, Manchester Memorial, Day Kimball in Putnam, and the Hebrew Home and Hospital in West Hartford.

Facing fines higher than the national average are: Bristol Hospital (.85 percent); Greenwich Hospital (.41 percent); Griffin Hospital in Derby (.97 percent); MidState Medical Center in Meriden (.78 percent); Milford Hospital (.76 percent); and St. Francis Hospital & Medical Center in Hartford (.39 percent). The other state hospitals will face lower penalties, including Lawrence & Memorial in New London, which will lose .13 percent of every Medicare payment for a patient stay; Bridgeport Hospital (.2 percent); Hartford Hospital (.1 percent); and Charlotte Hungerford in Torrington (.04 percent).

Fourteen state hospitals will face lower penalties than they did in the last year, with the biggest percentage point drops at Yale-New Haven, John Dempsey Hospital in Farmington, Saint Mary’s Hospital in Waterbury, Johnson Memorial Hospital in Stafford Springs, MidState and Danbury Hospital.

Readmission penalties are among a number of financial pressures weighing on hospitals in Connecticut and nationally. The federal government also is squeezing hospitals to reduce unnecessary inpatient stays, which has led to the controversial use of “observation status” as an alternative to admission. Patients who are deemed to be on observation status during a stay are not counted as admissions, but find themselves without Medicare coverage for nursing home care after discharge. That policy is being challenged in a lawsuit in federal court in Hartford.

One thought on “Medicare To Punish 24 State Hospitals For High Readmissions

  1. What this report describes is a crisis in healthcare for the elderly. We are not naming it such but that’s what it is. Ct is not special in this regard, but doesn’t have much to be proud of either. In the last few years Connecticut has been ranked among the highest in the use of dangerous anti-psychotic drugs, in the bottom third for home health measures, and by these findings, highest among hospital re-admissions. We don’t see it as crisis, because the old are sick and die anyway. We don’t want to think of this, its easier to talk about how costly care for the aged is, but given that cost of that care, it also seems unexamined that basic care and basic prevention can be routinely neglected in nursing homes and other settings. Maybe its hard to compare because the old have always been sick and died, but there are also going to be more, (of us!,) we’re living longer, but we’re also having sicker and more prolonged deaths . As a relative of nursing home residents I would like to see the state take the initiative with a comprehensive approach to this elder care crisis. Will healthcare facilities endeavor to educate families and the public about palliative care and basic resident rights, particularly in regard to changes in the system, and preserve their right to choices and informed consent?

    Will nursing home residents be able to receive adequate Emergency Room Care and are emergency room personnel trained and equipped to meet their special needs? Will regulators and healthcare facilities assure that basic care and prevention needs are met?

    A recent New York Times article described that there is an epidemic of poor oral care which leads to greater illness in the nation’s nursing homes. Is the state addressing this? When a consortium of interests including Medicare, the Department of Health, and our elected officials, identified the use of antipsychotic drugs to sedate nursing homes as a dangerous and sometimes fatal practice, they made a goal of reducing the use of those meds by 15% ; but this far from being achieved. Is it any wonder when the state law on the rights of nursing home patients includes a passage that says they have a “right” to these meds? Or when Nursing facilities that make use of the meds freely do not face any sanction from regulators? As we look at containing costs in the system, our elected officials and state administrators need to assure that elders are receiving the care that they need. We can not even be assured that they are receiving basic care now, but this is because we are not paying attention. These initiatives to reduce hospital admissions need to actually produce better care plans for nursing homes residents rather than reinforce neglect that already exists in the system. This is a problem that is coming to a life passage near you.

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