Medicare is fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatment, federal records released this week show.
In Georgia, 89 hospitals will be penalized for excessive readmissions, an analysis by Kaiser Health News shows. The federal government’s penalties, which begin their third year this month, are intended to jolt hospitals to pay attention to what happens to their patients after they leave.
The “fine” is a deduction by Medicare of a certain percentage of the reimbursement it pays hospitals. The average penalty in Georgia was 0.51 percent. Only one facility in the state, Fannin Regional Hospital in Blue Ridge, received the maximum penalty, 3percent.
Metro Atlanta hospitals that performed well include:
- Saint Joseph's, which paid no fines.
- Emory Hospital, no fines in the first two years and 0.02 percent for 2015.
- Northside Hospital, no fines for 2014 and 2015.
- Piedmont Hospital, 0.01 percent in 2013 and nothing in 2014. For 2015, however, the fines hit 0.46 percent.
- Wellstar Cobb cut its fines to 0.04 percent for 2015.
- Gwinnett Medical Center cut its already comparatively low rate to 0.04 percent for 2015.
Around the country, many hospitals are replacing perfunctory discharge plans — such as giving patients paper instructions — with more active efforts, such as ensuring that outside doctors monitor their recoveries and giving medications to patients who may not be able to afford them. Before the program, some hospitals resisted such efforts because they weren’t paid for the services, and, in fact, benefited financially when a patient returned.
Dr. Stephen Jencks, a consultant who was one of the first researchers to document the nation’s high readmission rates, said he was impressed overall by how much the fines have prompted hospitals to concentrate on their patients’ health after discharge. “This really fairly modest step” of penalties has “persuaded a lot of hospitals to talk in ways they simply were not talking 10 years ago,” he said.
Last year, nearly 18 percent of Medicare patients who had been hospitalized were readmitted within a month. While that is lower than past years, roughly 2 million patients return a year, costing Medicare $26 billion. Officials estimate $17 billion of that comes from potentially avoidable readmissions.
Under the new fines, three-quarters of hospitals that are subject to the readmission reduction program are being penalized. That means that from Oct. 1 through next Sept. 30, they will receive lower payments for every Medicare patient stay — not just for those patients who are readmitted. Over the course of the year, the fines will total about $428 million, Medicare estimates.
In New Jersey, every hospital but one will lose money this year. So will a majority of hospitals in 28 other states, including Georgia, California, Florida, Illinois, Massachusetts, New York, Ohio, Pennsylvania, Tennessee and Texas, as well as the District of Columbia, according to Kaiser’s analysis.
While some penalties are as small as a hundredth of a percent, hospitals with the highest readmission rates are losing 3 percent of each payment, an increase from a maximum punishment of 2 percent last year. The increase brings the top penalties to the full force authorized by the federal health law.
Medicare began evaluating readmissions in two new categories of patients this year — those initially admitted for elective knee or hip replacements, and those suffering lung ailments such as chronic bronchitis. Those patients were assessed along with the heart failure, heart attack and pneumonia patients Medicare has examined since the penalties began in October 2012.
As the penalties have played out, an increasing number of prominent experts are voicing concerns that the punishments are too harsh and doled out unfairly. For one thing, Medicare lowers payments to hospitals even if they have reduced their readmission rates from the previous year — so long as their rate is still higher than what the government believes is appropriate. Medicare uses the national readmission rate to help decide what appropriate rates for each hospital, so to reduce their fines from previous years or avoid them altogether, hospitals must not only reduce their readmission rates but do so better than the industry did overall.
“You have to run as fast as everyone else to just stay even,” Foster said. Only 129 hospitals that were fined last year avoided a fine in this new round.
Medicare officials, however, consider the competition good motivation for hospitals to keep on tackling readmissions and not to become complacent with their improvements.
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