Sunday, August 11, 2013

U.S. government fines more than 50 Oklahoma hospitals for Medicare patient readmissions

By ZIVA BRANSTETTER World Enterprise Editor on Aug 10, 2013, at 2:22 AM  Updated on 8/10/13 at 4:15 AM

More than 50 Oklahoma hospitals, including all of Tulsa's major hospitals, have been fined by the federal government for Medicare patients who return for treatment within 30 days of an inpatient stay. 

A provision of the Affordable Care Act, the financial penalties are part of a larger effort by the federal government to pay hospitals based on the quality of care they provide rather than the number of patients they treat. The readmission penalties, also levied last year, have sparked new efforts by hospitals statewide to help patients have a smooth recovery after leaving. 

Among the Tulsa hospitals fined were St. John Medical Center, Oklahoma State University Medical Center, two Saint Francis hospitals and two Hillcrest Medical Center locations, a Tulsa World analysis of federal data shows. 

The fines come in the form of deductions ranging from zero to 2 percent from future Medicare payments to the hospital. 

The hospitals were penalized if patients treated for three conditions - heart attack, heart failure or pneumonia - were discharged and then admitted to any hospital within 30 days. 

Because the Medicare program relies on tax dollars, ultimately taxpayers face higher bills when patients are readmitted. A Medicare advisory board has estimated that avoiding one in 10 readmissions could save $1 billion or more. 

The readmission fines were levied against 2,225 hospitals nationwide, about two-thirds of all hospitals. Statewide, 53 out of 91 hospitals received penalties. 

Dr. Peter Aran, senior vice president of quality for Saint Francis Health System, said the program came about after studies showed a high number of Medicare patients returning to the hospital after inpatient stays. 

"It shocked the government that one in five patients had to come back to the hospital (within one month), and we were funding that. At the 12-month interval, one out of every two patients ... came back," Aran said. 

Cheena Pazzo, a spokeswoman for St. John Health System, said the hospital reduced its overall readmission rate by 9 percent since the last quarter of 2011 through a variety of efforts. Patients are screened for readmission risk, and complex cases receive extra follow-up, Pazzo said in an email. 

"As part of the overall effort, we are emphasizing better communication among providers, family members and caregivers so they are empowered to manage follow-up care," she said. 

The Center for Medicare and Medicaid Services released data on the fines on its website last week. 

The fines vary widely by geography, with 14 of 22 hospitals in the Oklahoma City area receiving no fine and all but one receiving relatively low fines compared to Tulsa hospitals, the World's analysis shows. Midwest Regional Medical Center in Midwest City received the highest fine in that area, 0.77 percent. 

Out of 14 hospitals in Tulsa and its suburbs, six received no fine. 

A Durant hospital - the Medical Center of Southeastern Oklahoma - was among 19 hospitals in the nation to receive the full 2 percent penalty. A "60 Minutes" broadcast last year alleged the hospital and the company that owns it pressured doctors to admit patients regardless of medical need. 

Harmon Memorial Hospital in Hollis received a 1.89 percent penalty, ranking it among the 25 largest fines nationally. 

Last year, the hospital, operated by the Harmon County Healthcare Authority, and one of its doctors agreed to pay $1.5 million to settle claims of health-care fraud in the Medicare and Medicaid programs. The payment settled a whistleblower lawsuit brought by a former administrator of the authority. 

Officials with the Durant and Hollis hospitals could not be reached for comment. 

Rick Snyder, vice president of finance and information services with the Oklahoma Hospital Association, said hospitals in the state were prepared for the fines, also levied last year. 

"We've been actively working with hospitals to reduce readmissions," Snyder said. 

LaWanna Halstead, vice president of quality and clinical initiatives for the association, said 55 Oklahoma hospitals are taking part in a network focusing on 10 ways to improve patient outcomes. Those include avoiding blood clots, hospital-acquired infections and patient readmissions. 

"It's a very complicated issue," Halstead said. 

In the Tulsa area, Hillcrest Medical Center received the largest penalty, 0.62 percent of future Medicare billings. The fine was lower than last year's penalty, which was the maximum 1 percent. 

Angela Peterson, a spokeswoman for Hillcrest, said a new program at the hospital pairs registered nurses with patients who are at risk for readmission. The nurses, called Care Partners, work closely with patients to ensure they follow discharge instructions and can get to follow-up appointments. 

"Readmission to the hospital within 30 days is often not an issue of care provided in the hospital but is often the result of circumstances after a patient leaves the hospital," Peterson said. 

Saint Francis' hospitals at 61st and Yale and 10501 E. 91st St. were among Oklahoma hospitals penalized. 

Saint Francis received a penalty that represents less than half of 1 percent of all future Medicare billings in the coming fiscal year. The hospital estimates that will total about $360,000 in the next fiscal year. 

Aran said the program penalizes hospitals even if the reason for the patient's second hospital admission has nothing to do with the first admission. 

"With the readmissions program, two out of three hospitals (nationally) get penalized with this strict bar. That's why hospitals all over the country are working like we are to reduce readmission," Aran said. 

Dale Bratzler, associate dean and professor at the University of Oklahoma's College of Public Health, was among the authors of a 2011 medical study on readmissions. 

The study found that about one in five Medicare patients, 17 percent, hospitalized for pneumonia returned to the hospital within 30 days. 

Bratzler, an osteopathic physician, said readmission rates are higher for some diagnoses. One in four Medicare patients treated for heart failure return within 30 days, he said. 

To determine the readmission penalty, the federal government examines the rate at which Medicare patients with certain illnesses return to any hospital within 30 days of being treated. The rates are adjusted for patients with more severe illnesses, but some hospitals still end up on the losing end. 

"All the hospitals will tell you that if you have patients who have less access to care, they are more likely to be readmitted," Bratzler said. 

Hospitals won't be able to prevent all patients from returning after discharge but by coordinating with outside care providers, they can improve outcomes, he said. 

"Most experts feel that up to half of readmissions may be preventable with better coordination of care across settings. Again, that may vary by diagnosis. The 'correct' readmission rate is not zero, but Medicare feels that it can certainly be better than 20 percent."

Top 10 readmission fines

Here are the top 10 Oklahoma hospitals with the largest penalties for patient readmissions: 

  • Medical Center of Southeastern Oklahoma, Durant
  • Harmon Memorial Hospital, Hollis
  • Eastern Oklahoma Medical Center, Poteau
  • Pushmataha Hospital, Antlers
  • Choctaw Memorial Hospital, Hugo
  • Midwest Regional Medical Center, Midwest City
  • Pauls Valley General Hospital, Pauls Valley
  • Craig General Hospital, Vinita
  • Integris Clinton Regional Hospital, Clinton
  • Hillcrest Medical Center, Tulsa
Source: Tulsa World analysis of CMS data

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