Published: August 7, 2013 | Last Modified: August 7, 2013 11:05PM
By Jesse Buchanan Record-Journal staff
Two area hospitals will lose a portion of Medicare reimbursements for the second consecutive year after failing to meet national average readmission rates for heart conditions and pneumonia.
Masonic Home and Hospital in Wallingford will lose 1.14 percent of its Medicare reimbursements for patient stays, a penalty levied under the federal Hospitals Readmission Reduction Program which began last year as part of the Affordable Care Act. The program penalizes hospitals for patients readmitted within 30 days.
MidState Medical Center in Meriden faces a loss of .78 percent of reimbursements but won’t lose as much money as last year since it brought down its readmissions.
Both MidState and Masonic lost 1 percent of reimbursements last year, the maximum penalty. This year the maximum was 2 percent.
Masonic officials said the readmission reduction program penalizes hospitals that take a large number of older, sicker Medicare patients. The penalties amount to about $60,000, according to Masonic spokeswoman Margaret Steeves. Masonic patients, many of whom are referred by nursing homes, are commonly 85 years or older.
Medicare reimburses hospitals for care given to patients 65 years or older. Readmission rates are compared to national averages but are adjusted for sicker and high-risk populations, according to Medicare spokeswoman Kathryn Ceja. Hospitals with higher than national average readmission rates face penalties.
Twenty-four of Connecticut’s 31 hospitals will face Medicare penalties in the fiscal year that starts in October. None of the state’s hospitals will lose the maximum amount possible.
Statewide, Connecticut’s hospitals face an average penalty of .43 percent of Medicare funds for the number of readmissions within a month, which is higher than the national average. Hospitals in 12 states, including Massachusetts and Rhode Island, face higher average penalties.
Nationally, about 20 percent of hospitalized Medicare patients are back within 30 days, at an estimated cost of $17 billion a year, according to the Medicare Payment Advisory Commission.
Hospital administrators in the state say they have made many efforts to reduce readmissions in the past two years, and note that the new penalties are based on readmissions through June 2012. Medicare counts patients who originally went into the hospital with at least one of three conditions — heart attack, heart failure or pneumonia — and landed back in the hospital within 30 days for any reason, even if it was unrelated to the original stay.
Jack Greene, Midstate Chief Medical Officer, said efforts to reduce readmission since last year have shown results. Medicare takes data from the previous three years, and efforts from last year were able to reduce the penalty by 22 percent.
“We were certainly pleased we improved from last year,” Greene said.
MidState now works more closely with visiting nurses, rehabilitation centers and patients to communicate what needs to be done after a hospital admission. Howard Dobin, director of MidState’s hospitalist program, said patients at higher risk for readmission are given additional help understanding, for instance, how to take their medication.
Dobin expects MidState’s penalty to continue to drop.
Connecticut Hospital Association officials said they’ve worked to change the federal matrix for calculating readmissions. Only patients with heart conditions or pneumonia are counted for readmissions, but any illness that lands them in the hospital will count against that medical center. That penalizes a hospital for admitting a cancer patient for regularly scheduled chemotherapy if the patient had a heart attack within 30 days.
Mary Reich Cooper, association Chief Medical Officer, said that could and should be changed.
“The federal government is starting to take into account that some readmissions are planned readmissions,” she said.
Overall, hospitals have made strides in reducing readmissions.
“We’re starting to show results,” Cooper said. “We’re really proud of all the hospitals that have improved their outcomes from a year ago.”
Readmission penalties are among a number of financial pressures weighing on hospitals in Connecticut and nationally. The federal government also is squeezing hospitals to reduce unnecessary inpatient stays, which has led to the controversial use of “observation status” as an alternative to admission. Patients who are deemed to be on observation status during a stay are not counted as admissions, but find themselves without Medicare coverage for nursing home care after discharge. That policy is being challenged in a lawsuit in federal court in Hartford.