Newspaper article MinnPost.com

Medicare Fines 36 Minnesota Hospitals, among 2,610 Nationwide, for Readmission Rates

Newspaper article MinnPost.com

Medicare Fines 36 Minnesota Hospitals, among 2,610 Nationwide, for Readmission Rates

Article excerpt

This article was produced by Kaiser Health News.

Medicare is fining a record number of hospitals - 2,610 - for having too many patients return within a month for additional treatments, federal records show. Even though the nation's readmission rate is dropping, Medicare's average fines will be higher, with 39 hospitals receiving the largest penalty allowed, including the nation's oldest hospital, Pennsylvania Hospital in Philadelphia.

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. 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 supplies of medication to patients who may not be able to afford them. Others are still struggling to meet the new expectations. 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.

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 Hospital Readmissions 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 Minnesota, 36 hospitals are being penalized. [See pages 42-42 here for Minnesota hospital penalties for all three years of the program.]

More than 1,400 hospitals are exempted from the penalties, including certain cancer hospitals and critical access hospitals, as well as facilities dedicated to specific services such as psychiatry or rehabilitation. Maryland hospitals are also excluded because the state has a unique payment arrangement with Medicare. The fines are based on readmissions from July 2010 through June 2013.

In New Jersey, every hospital but one will lose money this year. So will a majority of hospitals in 28 other states, including California, Florida, Georgia, Illinois, Massachusetts, New York, Ohio, Pennsylvania, Tennessee and Texas, as well as the District of Columbia, according to a Kaiser Health News analysis of the penalties.

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.

The 39 hospitals where payments will be lowered by 3 percent include a number of specialty surgical hospitals, small community hospitals and the Pennsylvania Hospital, a major teaching facility. The hospital, founded in 1751 by Benjamin Franklin and Dr. Thomas Bond, is part of Penn Medicine. Hospital officials did not immediately respond to a request for comment.

Another 496 hospitals will lose 1 percent or more of their Medicare payments. Those include Northwestern Memorial Hospital and Rush University Medical Center in Chicago, Beth Israel Medical Center in Manhattan, Tufts Medical Center in Boston, and a few satellite hospitals owned by well-respected systems, including the Mayo Clinic and Geisinger Health System.

Medicare levied penalties against 433 more hospitals than it did last year. The average penalty this year is 0.63 percent, up from 0.38 percent last year, according to the KHN analysis.

Two more conditions added

One reason for the higher and more widespread fines is that this year Medicare began evaluating readmissions of two new categories of patients--those initially admitted for elective knee or hip replacements, and those suffering lung ailments such as chronic bronchitis. …

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