Medicare Penalizes 25 Hospitals For Readmissions, But Fines Lower Due To COVID

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Twenty-five Connecticut hospitals will lose some of their Medicare reimbursement payments starting this month as penalties for having too many readmitted patients. Still, in most cases, the fines are much lower than in previous years, new data from the Centers for Medicare and Medicaid Services (CMS) show.

In this year’s evaluation, CMS considered the COVID-19 pandemic and its impact on hospitals, excluding data for the first half of 2020 and Medicare patients readmitted with pneumonia, according to a report in Kaiser Health News.

Nationally, Medicare is penalizing 2,273 hospitals, the fewest since 2014, with an average payment reduction of 0.43%, Kaiser reported.

Hartford Health Care Photo.

CMS fined William Backus Hospital 1.42%.

In Connecticut, 69% of all hospitals in the program face fines, but most are under 1%.

Six hospitals saw significant drops in penalties, including Rockville Hospital, from 2.3% last year to 0.45% this year, and Bridgeport Hospital, from 2.15% to 0.7%.

The others are Bristol Hospital, from 1.34% to 0.28%; Manchester Memorial Hospital, from 1.8% to 0.74%; Middlesex Hospital, from 1.67% to 0.97%; and Waterbury Hospital, from 1.13% to 0.51%.

William Backus Hospital received the highest penalty this year among facilities in the state, at 1.42%, which is slightly lower than last year’s 1.56%.

“We are encouraged that many hospitals in our state showed improvement from last year or sustained past gains,” Alison Vail, RN, vice president of quality and patient safety, Connecticut Hospital Association, said in an email.Through the Connecticut Hospital Association, hospitals are working collaboratively and transparently to improve the quality of care delivered at hospitals and to focus on patient care needs outside the hospital walls.

“This ongoing collaboration is having a positive effect on patient care,” Vail said. “These efforts to support patients through programs that address social and health care needs will improve patients’ quality of life and minimize the need for hospital readmissions. Hospitals and health systems are committed to continuous quality improvement and will continue working together to achieve even better outcomes for patients.”

Lisa Freeman

Lisa Freeman, executive director of the Connecticut Center for Patient Safety, said, “It is important to move the focus from the monetary consequence of readmissions to the causal reason for them. While I commend our hospitals for much of the good work that was done, COVID or not, readmissions can and should be greatly reduced with well-coordinated hospital care, discharge planning, and aftercare.

“COVID provided a stress test for our health care system, and that provided a window through which the weaknesses that showed up should be identified and addressed,” Freeman said. “As much as hospitals don’t want to be penalized, for many reasons, patients don’t want to be readmitted either. Effective communication among all members of the patient care team, including the patient and home caregiver, coupled with consideration of discharge readiness and medication reconciliation as well as the other related factors must always be addressed—COVID or not.

The hospitals losing less than 1% reimbursement are Charlotte Hungerford, .38%; Danbury, .23%; Day Kimball, .77%; Greenwich, .24%; Hartford, 0.71%; John Dempsey, .58%; Johnson Memorial, .27%; and Lawrence + Memorial, .18%.

Also losing less than 1% reimbursement are MidState Medical, 0.62%; Norwalk, 0.09%; St. Mary’s, 0.6%; Sharon, 0.11%; St. Francis, 0.33%; St. Vincent’s, 0.54%; Stamford, 0.04%; Hospital of Central Connecticut, 0.08%; Windham Memorial, 0.15%; and Yale New Haven, 0.41%.

Griffin Hospital in Derby, Masonicare Health Center in Wallingford, Hebrew Home and Hospital Inc. in West Hartford and Connecticut Hospice Inc., Branford, were not penalized.

Connecticut hospitals exempt from the program include Connecticut Children’s in Hartford, Connecticut Valley Hospital in Middletown, Natchaug Hospital in Mansfield, Connecticut Mental Health Center in New Haven, Southwest Connecticut Mental Health in Bridgeport, Silver Hill Hospital Inc. in New Canaan and Albert J. Solnit Children’s Center in Middletown.

This is the 11th year for CMS penalties, enacted under the Affordable Care Act.  The maximum penalty is 3%.  The penalties take effect as of Oct. 1.

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