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

I-Team In-Depth

The Unknown Puts Offspring At Risk Of Sickle Cell Disease

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Most Connecticut residents who carry a trait for sickle cell disease don’t know it, resulting in thousands of people unwittingly risking having a child born with the debilitating illness, according to sickle cell disease specialists. The reasons for this vary: there’s a lack of knowledge about results of newborn testing for the trait, parents don’t always convey test results to their children, gaps in state record keeping, and state records that identify people with the disease or trait only go back to 2012. Also, doctors typically only test for the trait when a patient requests it. And people often don’t know they can have the trait even when sickle cell disease isn’t in their family. Dr. Biree Andemariam, director of the New England Sickle Cell Institute at UConn Health, said physicians should include trait testing in routine exams. “It should be standard care,” she said.

Women's Health

Yale-Led Study Seeks To Transform Heart Disease Diagnoses In Women

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Karen Lombardi, a school instructional coach, had just taken an unruly child out of a classroom when she felt severe chest pains. She drove to Yale New Haven Hospital, sweating profusely and hyperventilating, and was diagnosed with a heart attack. Five weeks later, she was back in the hospital with more chest pains. It was another four months before Lombardi, 61, learned the cause of her pain, received effective treatment and returned to active exercise. She considers herself lucky because many women with heart disease never get an accurate diagnosis.

I-Team In-Depth

The Migraine Breakthrough

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Migraines have baffled humankind at least as far back as the ancient Egyptians, who blamed the excruciating headaches, and their often-accompanying visual auras and nausea, on the supernatural. Now, in a development doctors are calling revolutionary, an international group of neurologists has deciphered the mystery of why people get migraines and, in doing so, has determined how to greatly reduce their frequency and severity. The discovery “has revolutionized our treatment of migraine,” said Dr. P. Christopher H. Gottschalk, a neurologist at Yale Medicine and a professor of neurology at the Yale School of Medicine. “I’m witnessing a change in the landscape,” said Dr. Sandhya Mehla, a headache specialist and vascular neurologist with Hartford HealthCare Medical Group. “I would say this is a milestone.”

The discovery, the fruit of 40 years of research, won four scientists in Sweden, Denmark and the United States the 2021 Brain Prize, the world’s most prestigious award in neurology.

Fines & Sanctions

Medicare Penalizes 26 CT Hospitals For High Readmission Rates

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Twenty-six Connecticut hospitals will lose some of their Medicare reimbursement payments over the next year as penalties for having too many readmitted patients, new data from the Centers for Medicare and Medicaid Services (CMS) show. Nationally, Medicare is reducing payments to 2,499 hospitals, about 47% of all facilities, with the average penalty being 0.64%, according to a report by Kaiser Health News (KHN). This year’s penalties were based on tracking patients from July 1, 2017 through Dec. 1, 2019, so the influx of patient care during the pandemic is not included, CMS said. In Connecticut, 72 % of all hospitals in the program will face a loss in CMS payments, beginning October 2021 through September 2022.

Disparities

With Demand For Community Health Workers Rising, So Does Need For Sustainable Funding

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New Haven Community Health Worker (CHW) Katia Astudillo helps dozens of her clients navigate the logistics of getting vaccinated and connects them with other health services. She even helps them find rental assistance. In and around New London, CHW Lizbeth Polo-Smith hands out flyers about COVID-19 safety and vaccinations at churches, laundromats, stores, warming centers for the homeless—anywhere she can. As COVID-19 laid bare Connecticut’s health care deserts, it now highlights the efforts of CHWs who labored in forgotten neighborhoods for years. In many ways, they have become a key factor in the state’s public health response for marginalized communities during the pandemic.

Disparities

School-Based Health Centers Remain Vital Resource During Pandemic 

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Thirteen-year-old Estrella Roman and her mother have made the 30-minute walk to Rogers Park Middle School in Danbury several times during the pandemic, even when the school has been closed for in-person learning. That’s because the school’s on-site health center is where Estrella, who emigrated with her family from Ecuador in 2019, receives routine vaccinations, wellness care, and treatment for headaches, among other health services. Estrella’s mother, Katherine, who doesn’t speak English, said through Estrella that she’s “very grateful” for the teachers who told her that Estrella could still receive care there even when schools were closed. She praised the school nurse as patient and Spanish-speaking and said she would not have known where to seek care if not for the school-based health center. During their three decades in operation, Connecticut’s school-based health centers – defined by the state as fully-licensed primary care facilities — have become a critical health care delivery option, especially for children who have limited access to regular medical care.

Health Care

State To Change ‘Problematic’ Health Care Pay Model

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For decades, Connecticut and other states have used a fee-for-service model to pay for health care: the provider bills for each service, every consult, every procedure, every test, every pill. State Comptroller Kevin Lembo and many others have come to view that system as seriously flawed. It not only contributes to skyrocketing medical costs but also fails to deliver optimum care, Lembo said. “The incentives in that model are problematic,” Assistant Comptroller Josh Wojcik said. “It incentivizes volume.

Fines & Sanctions

Medicare Penalizes Hospitals For High Readmission Rates

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Most Connecticut hospitals will lose some of their Medicare reimbursement payments over the next year as penalties for having too many readmitted patients, according to new data from the Centers for Medicare and Medicaid Services (CMS). Statewide, 25 of the hospitals evaluated – or 89% – will have reimbursements reduced, to varying degrees, in the 2021 fiscal year that started Oct. 1, according to a Kaiser Health News analysis of CMS data. Nationwide, almost half of hospitals, or 2,545 of them, will have their Medicare reimbursements cut, according to Kaiser Health News. The latest penalties were calculated using data from June 2016 through June 2019, meaning the influx of patients to hospitals seen amid the pandemic didn’t factor in.

14 Hospitals Penalized For High Infection Rates, Injuries

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Fourteen Connecticut hospitals are being penalized by the Centers for Medicare & Medicaid Services (CMS), losing 1% of their Medicare reimbursements this fiscal year for having high rates of hospital-acquired infections and injuries, new data show. The hospitals are among 786 nationwide being penalized under the Hospital-Acquired Conditions Reduction Program, which was created under the Affordable Care Act, according to a Kaiser Health News (KHN) analysis. The program is in its sixth year and the latest Medicare reimbursement penalties are for the current fiscal year, which began in October 2019 and runs through September. When assessing penalties, CMS considers the number of infections, blood clots, sepsis cases, pressure ulcers, and other complications that may have been prevented. The 14 hospitals losing 1% of their Medicare reimbursements are: Waterbury Hospital, Stamford Hospital, Lawrence + Memorial Hospital in New London, Johnson Memorial Hospital in Stafford Springs, Charlotte Hungerford Hospital in Torrington, Midstate Medical Center in Meriden, Middlesex Hospital, and Windham Community Memorial Hospital & Hatch Hospital in Willimantic.