Most hospitals in state face readmission fines

Print Friendly and PDF By: Andy Miller Published: Aug 5, 2013

Medicare will impose fines on 73 Georgia hospitals for excessive readmissions of patients within 30 days of discharge.

Kaiser Health News reported that 68 percent of eligible hospitals in the state received a penalty — roughly the national average.

In all, 2,225 hospitals nationally will have payments reduced for a year starting Oct. 1. Eighteen hospitals — though none in Georgia — will lose 2 percent, the maximum fine possible and double the current top penalty.

Another 154 will lose 1 percent or more of every payment for a patient stay, including three hospitals in Georgia: Elbert Memorial in Elberton; Coffee Regional in Douglas; and Crisp Regional in Cordele.

Hospitals that treated large number of low-income patients were more likely to be penalized than those treating the fewest poor people, Kaiser Health News reported. The total of readmission fines nationally is $227 million.

Here is a link to the national data, including that for Georgia hospitals.

Avoidable hospital readmissions cost Medicare billions of dollars a year. Overall, one in five patients on Medicare is readmitted to the hospital within 30 days of discharge. (Here’s a recent GHN article on how hospitals are reducing their readmission rates.)

Medicare’s readmission penalty program began in October 2012. Many Georgia hospitals saw their penalties reduced for the coming fiscal year. They include Northside Hospital Forsyth in Cumming, whose readmission fine dropped from 0.96 percent in fiscal 2013 to 0.27 percent in the current list.

Nationally, the average fine decreased from 0.42 percent in the first year of the program to 0.38 percent. Georgia’s average penalty is 0.32 percent.

The Georgia Hospital Association pointed out Monday that about 80 percent of Georgia hospitals have a new penalty rate below the national average.

“While GHA has expressed some real concerns to [the Centers for Medicare and Medicaid Services] about the methodology used for penalizing hospitals — hospitals are being penalized for when a patient fails to comply with a physician’s instructions and is later readmitted to the hospital  —  we know that Georgia hospitals are taking these penalties very seriously and are working hard to improve in the areas they can control,’’ Kevin Bloye, a GHA vice president, said in an email to GHN. “It is clear that the data reflect that.’’

Medicare says the penalty program helps counter a system that inadvertently rewards hospitals for readmissions, Kaiser Health News reported. Because readmission of a patient means the hospital can be paid for two stays instead of one, the hospital actually benefits financially if the patient’s health deteriorates after discharge.

Officials hope that hospitals hit with fines will do a better job of training and encouraging patients to maintain their health after discharge, avoiding needless readmissions. The Medicare Payment Advisory Commission has estimated that 12 percent of Medicare patients may be readmitted for potentially avoidable reasons.

The penalties are based on readmissions of Medicare patients who were initially admitted to a hospital with a heart attack, heart failure or pneumonia and were discharged between July 2009 and June 2012.

Those who ended up in any hospital within 30 days after discharge were counted, unless the readmission had already been planned when the patient was discharged. Hospitals that had more readmissions than Medicare predicted after taking the severity of their patients’ illness into account received fines, KHN reported.

Dr. Eric Coleman, director of the Care Transitions Program at the University of Colorado Anschutz Medical Campus, said more hospitals are taking readmissions seriously in part because of the penalties. “People are starting to recognize that renaming discharge planning does not actually improve your readmissions rate,” Coleman told KHN. “Hospitals have moved past ‘is this for real?’ or ‘should we do something?'”

In the third round of the program, starting in October 2014, Medicare is increasing the final maximum penalty to a 3 percent payment reduction for all patient stays. Also that year, Medicare plans to consider readmissions for more conditions, including chronic lung disease and elective hip and knee replacements.

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