All but one of Connecticut’s acute-care hospitals will lose Medicare reimbursement in 2015-16 as a penalty for high readmissions of discharged patients, new federal data show.
The penalties against 28 hospitals mean Connecticut has one of the highest percentages nationally – more than 90 percent — of hospitals facing Medicare reductions. Only the Hebrew Home and Hospital of West Hartford escaped penalties; the Connecticut Children’s Medical Center is exempted from the federal program.
None of the state’s hospitals faces the maximum 3 percent reduction to Medicare reimbursement, but seven face reductions of more than 1 percent. They are: Milford Hospital (1.70 percent); Middlesex, in Middletown (1.38); Johnson Memorial, in Stafford Springs (1.27); Charlotte Hungerford, in Torrington (1.19); St. Vincent’s, in Bridgeport (1.09); Manchester Memorial (1.04); and Yale-New Haven (1.03).
This is the fourth year that the federal Medicare program has been tracking the rates at which patients discharged from hospitals after treatment for certain conditions, including heart failure and pneumonia, are readmitted within 30 days. Hospitals that exceed Medicare’s standards lose a percentage of their Medicare funding.
Nationally, the majority of hospitals – more than 2,500– are being penalized, according to an analysis by Kaiser Health News. About 800 will not face penalties, while 514 will face a loss of 1 percent or more. Thirty-eight hospitals will face the maximum 3 percent penalty.
All of the Connecticut hospitals that will lose Medicare money in the fiscal year starting Oct. 1 also were penalized this year. In the first year of the program, only 21 state hospitals were penalized, but that number has crept up in subsequent years.
Hospital administrators say they have made myriad efforts to reduce readmissions in the past four years. They note that Medicare counts patients who return to the hospital within 30 days for any reason, even if it was unrelated to the original stay. Also, some hospitals argue that the federal government does not take into account the socio-economic conditions of their patient populations, saying those factors affect the likelihood of readmissions but are beyond their control.
The Connecticut Hospital Association (CHA) has been working with member hospitals and Medicare quality-improvement groups to address problems leading to high readmissions, such as infections, inappropriate antibiotics use, and lack of follow-up care after hospitalization. The CHA also has “ramped up” data reporting on readmissions among hospitals, said Dr. Mary Cooper, vice president and chief quality officer for the association.
Noting that the new penalties are based on readmissions only through June 2014, Cooper said some of the recent improvements would pay off in future rates.
“We do know we have made progress in the last three years” by sharing best practices and improving communication with patients after discharge, she said. “More than any other preventable harm, (readmissions) is a problem that we will not be able to solve by ourselves.” Collaboration with nursing homes, primary care physicians and other providers is key to avoiding re-hospitalizations, she said.
Cooper said one area that Connecticut needs to tackle is the lack of palliative care for patients with late-stage diseases, who cycle in and out of hospitals instead of hospice or community-based care. “We need to address end-of-life care more proactively,” she said.
The new data show that a number of hospitals – including the Hospital of Central Connecticut, Midstate Medical in Meriden, St. Francis in Hartford, and St. Vincent’s — will face lower penalties in the new fiscal year than in 2014-15.
The average penalty for Connecticut hospitals in the new fiscal year is 0.66 percent – slightly higher than the national average of 0.61 percent. Some hospitals will face only small reductions, including Saint Mary’s in Waterbury (0.05 percent); Lawrence & Memorial in New London (0.11 percent); John Dempsey in Farmington (0.17); and Stamford (0.15).
Cooper said, “Any loss hurts, from any source,” in the current financial environment.
Nationally, about 20 percent of all hospitalized Medicare patients are back within 30 days, at an estimated cost of $17 billion a year, according to the Medicare Payment Advisory Commission.
To view all the Medicare penalties in Connecticut and nationally click here.