Most Connecticut nursing homes will see their Medicare reimbursements reduced in the coming year for having high resident readmission rates to hospitals. Of Connecticut’s 224 nursing homes, 75 percent (168) are being penalized by Medicare based on how often their residents were re-hospitalized within 30 days of discharge. Twenty-five percent (56) in Connecticut are receiving bonuses for having few readmissions, according to a Kaiser Health News (KHN) analysis of data from the Centers for Medicare and Medicaid Services (CMS). This is the first time nursing homes are being penalized or rewarded based on how many of their residents are readmitted to hospitals for conditions that could have been prevented. Medicare has administered a similar program for hospitals since the 2013 fiscal year.
Most Connecticut hospitals will lose a portion of their Medicare reimbursement payments over the next year as penalties for having high rates of patients being readmitted, new data from the Centers for Medicare & Medicaid Services (CMS) show. Statewide, 27 of the 29 hospitals evaluated—or 93 percent—will be penalized in the 2019 fiscal year that began Oct. 1, according to a Kaiser Health News analysis of CMS data. The Medicare program has penalized hospitals since the 2013 fiscal year for having high rates of patients who are readmitted within a month of being discharged. Nationally, hospitals will lose $566 million in penalties, which were instituted as part of the Affordable Care Act to encourage better health care delivery.
Three years ago, Meredith Phillips’ mother, Georgia Svolos, fell and broke her kneecap, setting off a downward spiral that landed her in nursing homes on and off for a year. In one facility, she fell and broke her knee again, necessitating more surgery. All of the facilities were noisy and chaotic, and one smelled of feces. So, when Phillips learned recently about moves by the Trump administration to ease regulations and fines on nursing homes, she was alarmed. “I’m horrified and frightened,” says Phillips, who lives in Westbrook.
About half of Connecticut hospitals—15 out of 31—will lose part of their Medicare payments in 2018 as a penalty for having relatively high rates of patients who acquired preventable injuries and infections while hospitalized. The hospitals are among 751 nationwide that will lose 1 percent of their Medicare reimbursements in this fiscal year. The penalties are part of the Centers for Medicare and Medicaid Services’ (CMS) Hospital-Acquired Condition Reduction Program, which is part of the Affordable Care Act. The program penalizes hospitals with the highest rates of patients who got infections from hysterectomies, colon surgeries, urinary tract catheters and central line tubes. It also tallies those who suffered from blood clots, bed sores or falls while hospitalized.
When doctors and patients communicate well, research shows that patients are more likely to follow treatments, recover more quickly and are less likely to be the victims of medical errors. But with an average office visit of just 18 minutes and an increasingly complex variety of diagnostic and therapeutic options, good communication may be modern medicine’s final frontier. In this podcast, sponsored by ConnectiCare, Dr. Juan Estrada, medical director of Sanitas Medical Centers and Lisa Freeman, director of the Conn. Center for Patient Safety, provide tips on how to communicate with your doctor. A recent patient survey by ConnectiCare found that patients generally rated communication with their doctors highly, but there were concerning gaps.
Many consumers who obtain insurance through Connecticut’s health care exchange don’t understand the plans they buy—and can struggle to access care as a result, according to a new report. Insurance plans typically use complicated language that is difficult to understand, according to the Health Disparities Institute, UConn Health. As a result, some patients have trouble accessing care, experience delays in care, encounter administrative hassles and face other hurdles, the study found. The institute conducted a statewide poll last year among 516 adults who enrolled in qualified health plans through Access Health CT (AHCT), the state health insurance exchange created under the Affordable Care Act. Many struggled to understand basic insurance terms like “premium,” “deductible” and “co-pay.”
More needs to be done to educate all health insurance consumers, regardless of where they buy their policies, said Lisa Freeman, executive director of the nonprofit Connecticut Center for Patient Safety.
Health care organizations’ information technologies and workflows often don’t support each other, according to a patient care-focused nonprofit that flagged the problem as one of the top safety issues facing the industry. The ECRI Institute, which recently released its third annual ranking of the Top 10 Patient Safety Concerns for Healthcare Organizations, reported that patient identification errors and inadequate management of behavioral health issues in non-behavioral health settings were its No. 2 and No. 3 issues for health care organizations. When a health IT system is introduced, health care organizations should tailor it to their workflow, and vice versa, according to ECRI, which is based in Pennsylvania.