Health Care In The States

Hospitals React To Readmission Penalties

By Diane Webber

August 17th, 2012, 8:53 AM

This week, a KHN analysis of Medicare data showed that 2,211 hospitals will face penalties in October for having too many patients readmitted for care within 30 days of discharge.

Hospital executives around the country have had something to say about those penalties and the new policy. Here’s a round-up of how the story played as it was picked up and localized by some of our reporting partners at NPR member stations around the country.

Pennsylvania & Delaware

Taunya English, covering the story at WHYY in Philadelphia, reported on resistance to the policy coming from the regional hospital association.

“[Medicare] needs to remember that people are not cars,” Curt Schroder, head of the Delaware Valley Healthcare Council, told English. “They seem to be treating hospitals like auto repair shops. In other words, ‘You should be able to change the tire, send them on their way and not see them for another 5,000 miles.’”

English also interviewed Coy Smith, vice president for patient-care services and chief nursing officer at St. Francis Hospital in Wilmington, Del. St. Francis is facing a partial penalty— 0.66 percent of their Medicare reimbursements out of a possible 1 percent hit.

“We are looking at better handoffs to home care, skilled nursing facilities, better discharge preparation of patient families and using home care as an avenue to really track them. Because it’s the right thing to do, truly,” Smith told English. “But having these penalties over our head does kind of make a difference.”

Smith made the point that St. Francis has lowered readmission rates for all three categories in the past 18 months, but the new ranking uses historical three-year data from 2008 to early 2011, English reported.

New York

In New York, WNYC’s Fred Mogul wrote that the “list of penalized hospitals includes some of the region’s biggest players: city hospitals, like Bellevue, Jacobi, Coney Island and Elmhurst; academic medical centers such as Beth Israel, St. Luke’s-Roosevelt and Mt. Sinai; and suburban ones like North Shore and Hackensack medical centers.”

Jim Mandler, a spokesman for Continuum Health Partners, which owns Beth Israel and St. Luke’s-Roosevelt, told Mogul that the company is addressing the problem, but New York City may be a special case. “The complex issues that urban healthcare providers face, particularly here in New York City, clearly affect readmission rates and contribute to rates that are above national averages,” said Mandler.

Georgia

At Atlanta’s WABE, Jim Burress reported that 40 area hospitals will pay a penalty.

Vi Naylor, executive vice president of the Georgia Hospital Association, told Burress that it’s ok for hospitals to be held accountable for quality, but the organization would like to see other metrics used. And Dr. Ashish Jha, health policy professor at Harvard, told Burress: “Not all readmissions are bad.”

Hospitals with high readmission rates often have low mortality rates, Jha said, and those mortality rates are a better assessment of quality than readmissions.

One surprise in Atlanta: the beleaguered safety net hospital Grady Memorial got a penalty of one tenth of 1 percent, among the lowest in all of Georgia.

Minnesota

Minnesota had relatively good news in the analysis, as Minnesota Public Radio’s Elizabeth Stawicki reported: No hospital in the state got the maximum penalty. From Stawicki’s story:

Mayo Clinic’s Health System in Fairmont was the highest at 0.81 percent. Sanford Medical Center in Worthington and Fairview Ridges Hospital in Burnsville both face penalties of 0.43 percent.

Mayo is concerned about any unnecessary readmission, said Kevin Burns, regional director of public affairs for Mayo.

“Every patient deserves the best possible care, the very best comprensive treatment regardless of our cost to provide that treatment,” he said. …

Dan Anderson, president of Fairview’s community hospitals, said the penalty will amount to about $100,000. He says the penalty is perplexing because the government recognized Fairview for its ability to improve care and reduce cost. But he says Fairview supports what Medicare is doing.

“No patient wants to be readmitted if they don’t have to be and we don’t want to have them there if we can figure out a way to help them avoid it,” Anderson said.

Wisconsin

Wisconsin is another good-news state, where Wisconsin Public Radio’s Shamane Mills, reported that about 70 percent of the hospitals won’t be penalized, and no hospital will get the full penalty. Kelly Court, chief quality officer at the Wisconsin Hospital Association told Mills that the success on readmissions is due to coordination.

Court said discharged patients have to get good care from community doctors, home care agencies and nursing homes when they leave. “Hospitals can only do so much to prevent the readmission, like [making] sure patients understand their discharge instructions, understand their medications, make a good transition to a physician after the patient leaves the hospital,” Court said. “But once the patient leaves, the hospital has very little control.”

Related post: Denver Health: Low Readmission Rate Not Easy To Emulate

3 Responses to “Hospitals React To Readmission Penalties”

  1. Folks need to remember that hospitals do not admit or discharge patients. Doctors make the decisions, craft a plan of care (sometimes), discharge the patient and (are supposed to) follow-up with the patient after discharge. The problem is the physician’s faulty memory-based decision-making process, a failure of the human mind to manage the complexity of medicine and apply medical knowledge to the unique individual patient. Penalizing hospitals for physician errors and mismanagement is the practical application of the “Executive Monkey Experiment.” The physicians make the errors but the hospitals get penalized. If you want to gain profound knowledge of the problems with our medical-industrial complex and understand a future system that will pull us out of the crisis, read my book, “Discovering the Cause and the Cure for the American Health Care Crisis.”

  2. John Spek says:

    Why is anyone surprised?

    ACA already admitted that there were too few providers, too few resources for care and drugs, and that poverty level patients needed help

    ACA was designed so the penalties went in before the fixes were started

    A discharge of a poverty level patient,
    into an area with low provider coverage,
    low quantity of drug outlets,
    low amount of outpatient follow up care

    when they have NO MONEY to buy the care they need is a sure fire way to have a fail

    By design, the drafters of ACA wanted Hospital payments to be cut
    otherwise fixes that hospitals can not do, or are not paid to do
    would have been put in before penalties were assessed

    We are in the ” It was passed, now we find out what is in it” phase of ACA

  3. Harry says:

    Didn’t hospital execs all across America come together and send their Washington lobby group to Congress in 2010 to hammer out a deal with regard to what they would agree to in the Affordable Care Act (ACA)? Did they forget that the ACA was designed with a huge amount of input from the insurance lobby, the doctor’s lobby, the pharma lobby, the medical device lobby, and yes…

    The hospital lobby!

    They all sat down with members of Congress and wrote the ACA together and agreed to the pains and the gains contained in the new law. Now, the hospitals are whining! Great big crocodile tears! That’s BS! Hospitals stand to gain huge profits after 2014 when virtually everybody that walks through their doors will have comprehensive health insurance. No more charity care! Exactly like the residents of Massachusetts have with Romneycare. What hospitals need to do is suck it up and live with the agreement that their lobby worked out and stop crying and whining. They made the deal, live with it and shut up!

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