Two-thirds of Georgia hospitals will receive Medicare fines for having too many discharged patients return within a month for additional care, federal data show.
The 67 percent of Georgia hospitals facing penalties is higher than the national average of 54 percent, according to a Kaiser Health News analysis.
The readmission penalties, launched as part of the Affordable Care Act, seek to encourage hospitals to pay closer attention to what happens to patients after discharge.
Since the fines began, national readmission rates have declined, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month of being released, Kaiser Health News’ Jordan Rau reported this week.
The fines will be applied to Medicare payments when the federal fiscal year 2016 begins in October. In this round, the average Medicare payment reduction is 0.61 percent per patient stay. Georgia’s average penalty is 0.47 percent.
The maximum possible fine is 3 percent. Piedmont Henry Hospital in Stockbridge will get the highest fine in Georgia, at 2.59 percent.
The next highest is Houston Medical Center in Warner Robins, at 1.95 percent, followed by Elbert Memorial in Elberton, at 1.53 percent.
The Georgia Hospital Association said Tuesday that it sees progress on readmission rates. The organization said 32 states have a higher average penalty than Georgia. And of the 89 Georgia hospitals that will be penalized, 57 will see their penalties decrease from fiscal 2015 levels, GHA said.
“Although many hospital readmissions are outside of the control of the hospital, Georgia hospitals take these reports very seriously and continue to work diligently in making improvements in areas that can be controlled,” Dr. Doug Patten, chief medical officer for GHA, said in a statement.
Disputes about fairness
The fines are based on readmissions between July 2011 and June 2014 and include Medicare patients who were originally hospitalized for heart attack, heart failure, pneumonia, chronic lung problems, or elective hip or knee replacements.
Avoidable hospital readmissions cost Medicare billions of dollars a year.
Medicare has said the penalty program helps counter a system that inadvertently rewards hospitals for readmissions. Under that system, a readmission counts as a separate hospital stay, so the facility gets paid for two stays instead of one.
For each hospital, Medicare determined what it thought the appropriate number of readmissions should be, based on the mix of patients and how the hospital industry performed overall, KHN reported. If the number of readmissions was above that projection, Medicare fined the hospital.
These lower payments will affect three-quarters of hospitals or more in Alabama, Connecticut, Florida, Massachusetts, New Jersey, New York, Rhode Island, South Carolina, Virginia and the District of Columbia.
KHN found that fewer than a quarter of hospitals face punishments in Idaho, Iowa, Kansas, Montana, Nebraska, North Dakota and South Dakota.
Most of the 2,232 hospitals spared penalties this year were excused not because Medicare found their readmission rates acceptable, but because they were exempt from being evaluated, the article said. These exemptions came because the hospitals specialized in certain types of patients, such as veterans or children; because they were specially designated “critical access” hospitals; or because they had too few cases for Medicare to assess accurately.
Medicare also penalizes hospitals with high rates of infections and other avoidable occurrences of patient harm.
Christopher Press, a consultant with Morgan Healthcare Consulting, said Tuesday that hospitals are increasingly concerned about the readmission penalties, and are changing their practices as a result.
Hospitals have been lobbying both Medicare and Congress to take into account the socioeconomic background of patients when assessing readmission penalties, Kaiser Health News reported. They argue that some factors for readmissions — such as whether patients can afford medications or healthy food — are beyond the hospitals’ control.
The Medicare Payment Advisory Commission, which advises Congress, has suggested changing the readmission penalties.
“Hospitals should not be penalized simply because of the demographic characteristics of their patients,” Sens. Joe Manchin (D-W.Va.) and Roger Wicker (R-Miss.) wrote in the Journal of the American Medical Association. The senators have introduced a bill to consider socioeconomic factors when calculating the penalties, the KHN article reported.
But last Friday, the federal Centers for Medicare & Medicaid Services reiterated that it has no plans to make such changes in the program, noting that some safety-net hospitals have been able to keep their readmission rates low.
“While we appreciate these comments and the importance of the role that sociodemographic status plays in the care of patients,” the agency wrote in the rule, “we continue to have concerns about holding hospitals to different standards for the outcomes of their patients of low sociodemographic status because we do not want to mask potential disparities or minimize incentives to improve the outcomes of disadvantaged populations.”
Other Georgia hospitals getting a penalty of more than 1 percent are: Chestatee Regional in Dahlonega, 1.37 percent; Fannin Regional in Blue Ridge, 1.3 percent; University McDuffie County Regional in Thomson, 1.2 percent; Spalding Regional in Griffin, 1.13 percent; Habersham County Medical Center in Demorest, 1.07 percent; Colquitt Regional at 1.04 percent; and Redmond Regional in Rome, 1.02 percent.