In South Florida, reducing hospital readmissions key to reform

  

SOUTH FLORIDA READMISSIONS CAN BE COSTLY FOR HOSPITALS

• 30 hospitals in Miami-Dade and Broward counties will be penalized by Medicare in 2014 for excessive readmissions.

• 5 hospitals in Miami-Dade and Broward counties will receive no readmission penalty from Medicare in 2014.

• 11 hospitals received increased penalties from 2013 to 2014.

• 22 hospitals received decreased penalties from 2013 to 2014.

• 2 hospitals had no change in their penalties from 2013 to 2014.

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Locally, the average penalty in 2014, the second year of Medicare’s readmission reduction program, is .46 percent. Among the hospitals affected:

• Baptist Hospital of Miami increased its penalty from .18 percent in 2013 to .25 percent in 2014.

• Broward Health Medical Center in Fort Lauderdale reduced its penalty from .19 percent in 2013 to 0 percent in 2014.

• Jackson Health System in Miami-Dade reduced its penalty from .85 percent in 2013 to .73 percent in 2014.

• Memorial Regional Hospital in Hollywood increased its penalty from 1 percent in 2013 to 1.06 percent in 2014.

• South Miami Hospital reduced its penalty from .03 percent in 2013 to 0 percent in 2014.

Source: Kaiser Health News

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BY DANIEL CHANG

DCHANG@MIAMIHERALD.COM

Most South Florida hospitals are improving their quality of care by one important measure under federal healthcare reform: reducing the number of Medicare patients readmitted within a month, according to recently released government data analyzed by Kaiser Health News.

But while many hospitals in Broward and Miami-Dade counties have reduced their readmission rates, Medicare identified 30 hospitals in the region that remained too high. Those hospitals will receive lowered Medicare reimbursement payments for one year beginning Oct. 1 as part of the government program’s efforts to pay healthcare providers for the quality of care they deliver and not just the number of patients they serve.

The effort seems to be working: Of the 35 area hospitals included in the federal data, a majority — 22 — received decreased penalties for 2014 compared to the prior year. Only five South Florida hospitals met Medicare’s readmission standards and will not be penalized at all, up from the three that received no penalty in 2013. And nearly a dozen — including Memorial Regional in Hollywood and Palm Springs General in Hialeah — will pay bigger fines.

The readmissions reduction program, which began in October 2012, is one of Medicare’s toughest, in part because there is no reward for improvements, and it’s not optional. Penalties for 2014 are based on readmissions of Medicare patients who originally were admitted to a hospital for a heart attack, heart failure or pneumonia and were discharged between July 2009 and June 2012.

Patients readmitted to any hospital within 30 days counted against the discharging hospital, unless the readmission had been planned when the patient originally left the hospital.

Hospitals that had more readmissions than Medicare predicted after adjusting for the severity of patients’ illnesses received a reduction in total payments.

Because Medicare applies the penalties to every payment for a patient stay, hospitals can only estimate the dollar amount of the fines.

One example: At Jackson Health System in Miami, penalties totaled about $900,000 for the year, hospital administrators said. Jackson’s penalty rate was .85 percent and dropped to .73 percent for 2014.

Healthcare experts believe the program will work to improve the overall quality of hospital care while helping to control medical costs by reducing readmissions.

The Medicare Payment Advisory Commission (MedPAC), which reports to Congress, has estimated that 12 percent of Medicare patients may be readmitted for potentially avoidable reasons. Preventing one out of every 10 of those readmissions could save Medicare $1 billion, MedPAC says.

Sal Barbera, a former hospital executive who teaches healthcare administration at Florida International University, said Medicare’s readmission reduction program has forced hospital administrators across the country to assume additional responsibilities at their own expense to ensure the well-being of their discharged patients

“It’s going to really move hospitals toward looking further than, ‘Hey, here’s a patient to discharge,’ ’’ Barbera said. “Now they’re going to have to look at the support a patient has when they go home. Who’s going to watch after them? Do they have a home? Do they need more education on medication?’’

Some South Florida hospitals are opening pharmacies on site so they can send patients home with medications, Barbera said, noting that patients’ failure to fill a prescription or follow instructions for medication frequently leads to readmissions.

At Memorial Regional in Hollywood, pharmacists and case managers visit the homes of targeted elderly patients after discharge to ensure they are taking prescribed medications, eating appropriate diets and making follow-up appointments with primary care physicians, said Dr. Stanley Marks, chief medical officer and senior vice president for Memorial Healthcare System, which includes Memorial Regional, Memorial West, Memorial Pembroke and Memorial Miramar.

“Those are the kinds of things — reconciling the medications that people are on, assuring they have an appointment with their primary care physician, assuring that the environment is safe for them to go home — that can actually decrease readmissions,’’ Marks said. “There’s a lot of responsibility placed on the hospital, and we’re responding.’’

Yet despite such programs, Memorial Regional was one of two South Florida hospitals whose readmission penalties increased to more than 1 percent from 2013 to 2014.

Memorial’s three other hospitals, however, all had their readmission penalties reduced from 2013 to 2014.

Marks said Memorial Regional “does tend to get sicker patients than the other hospitals,” and also skews to what he calls the “super elderly’’ or those over the age of 85 years old. The hospital also sees a higher number of Medicaid and indigent patients than its sister hospitals.

Reducing readmissions can be a challenge, he said, because physicians and nurses are effective at delivering care to patients in hospitals, not on the outside, where patients can no longer be as closely monitored.

“That becomes the real challenge,’’ he said. “Who is that population of patients that’s at higher risk for not doing what they’re supposed to be doing? Who’s going to go home and their first stop is going to be McDonald’s if they’re in congestive heart failure?’’

Healthcare experts agree that elderly patients with multiple medical conditions can be difficult to keep out of the hospital. Hospitals that treat large numbers of poor people also have been disproportionately affected by Medicare readmission penalties nationwide, though locally some of those safety net hospitals performed very well.

Broward Health Medical Center in Fort Lauderdale, a safety net hospital for Broward County, is one of five South Florida hospitals that will receive no penalty from Medicare next year after sufficiently reducing readmissions. Last year, Broward Health received a penalty of .19 percent.

The hospital serves a significant number of Medicaid and indigent patients, said Dr. Marc Bivins, medical director for quality and clinical resource management.

Bivins said Broward Health administrators, physicians, nurses, home health workers and case managers began working on reducing readmissions several years ago when they realized federal healthcare reform would focus on correcting the incentive hospitals have to readmit patients: More readmissions result in more billing.

Broward Health uses a patient assessment before discharge and “transition coaches” to visit discharged patients at home, ensuring they follow medical instructions and receive needed support. Broward Health also established “continuity clinics” at the hospital to improve access to primary care physicians for indigent patients, Bivins said. Preventive care is considered key to reducing hospital stays.

The hospital’s readmission reduction efforts are applied to all patients, he said.

“We feel like appropriate care is something we should be delivering to everyone,’’ Bivins said.

Jackson Health System, Miami-Dade’s public hospital network, takes a similar approach to reducing readmissions by assessing targeted patients while they are still hospitalized and sending “health coaches’’ to their homes after discharge, said Kevin Andrews, vice president and chief quality officer.

Patients with any of about 25 diagnoses, including diabetes and hypertension, are paired with a “nurse navigator” who assesses their needs, helps with appointments with doctors, nutritionists and social workers, and educates patients about disease progression and navigating the healthcare system.

Jackson also established “transitional clinics’’ in the community exclusively for discharged patients because the hospital system’s primary care clinics were backlogged, Andrews said.

At the transitional clinics, discharged patients can receive a follow-up visit with a physician or a nurse practitioner, typically within seven to 10 days after leaving the hospital. The goal is to change patient behavior so they visit the doctor regularly and learn to manage chronic conditions such as heart disease and diabetes.

“There’s no magic bullet,’’ Andrews said of reducing readmissions, “and it’s not one thing.’’

But there’s a clear financial incentive. Unless hospitals succeed at reducing readmission rates, they will pay stiffer penalties.

For 2014, Medicare will increase the maximum possible penalties to 2 percent of the total payments. And for 2015, that number goes to 3 percent — the same year that the federal healthcare law will add hip and knee surgery and chronic obstructive pulmonary disease to the list of conditions used to determine the penalties.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

http://www.miamiherald.com/2013/08/10/v-fullstory/3555331/in-south-florida-reducing-hospital.html

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Medicare penalties hit hospitals in Roanoke, New River Valleys

HOSPITAL READMISSION PENALTIES

The Affordable Care Act imposes reductions in Medicare reimbursements to hospitals with too many patient readmissions. Below is a list of area hospitals, with their fiscal year 2013 readmission penalty, FY 2014 penalty, and percentage of change.

• LewisGale Hospital Alleghany: .25 percent, .65 percent, .40 percent
• Bedford Memorial Hospital: .28 percent, .41 percent, .13 percent
• Carilion Franklin Memorial Hospital: 0 percent, .03 percent, .03 percent
• Carilion Roanoke Memorial Hospital: .07 percent, .05 percent, -.02 percent
• Carilion New River Valley Medical Center: .70 percent, .41 percent, -.29 percent
• Carilion Tazewell Community Hospital: .58 percent, .37 percent, -.21 percent
• LewisGale Medical Center: .64 percent, .81 percent, .17 percent
• LewisGale Hospital Montgomery: .31 percent, .38 percent, .07 percent
• LewisGale Hospital Pulaski: 1 percent, 1.59 percent, .59 percent

Source - Kaiser Health New analysis of CMS data.

MORE REGIONAL HEALTH CARE

Learn more about the Affordable Care Act through our occasional series Understanding 'Obamacare'

by

LAURENCE HAMMACK | 981-3239

Sunday, August 11, 2013

Nine hospitals in a region that stretches from Bedford to Tazewell will see their Medicare reimbursements cut this year for having too many patient readmissions.

The penalties, part of the new federal health care law, are aimed at prodding hospitals nationwide to do a better job of making sure that patients admitted with heart problems and pneumonia don’t wind up back in the hospital too quickly.

Starting in October, hospitals in the region will have their Medicare payments docked from .03 percent to 1.6 percent.

The government program — described as a “blunt instrument” by one hospital industry advocate — has resulted in payment reductions for about two-thirds of the nation’s hospitals.

A total of $227 million will be withheld from 2,225 hospitals in the coming fiscal year, according to Kathryn Ceja, a spokeswoman for the U.S. Centers for Medicare & Medicaid Services.

In the Roanoke and New River valleys, all four LewisGale hospitals and five run by Carilion Clinic will have their payments reduced.

The hospital with the highest readmission rate, LewisGale Hospital Pulaski, will face the toughest penalty — 1.6 percent of its Medicare reimbursements for a year, beginning Oct. 1.

Affected to a lesser degree were the region’s two major hospitals, LewisGale Medical Center in Salem and Carilion Roanoke Memorial Hospital. Payments to LewisGale will be reduced by .81 percent; the penalty for Roanoke Memorial will be .05 percent.

The penalties are part of a program that took effect last year under the Patient Protection and Affordable Care Act.

In an effort to cut down on avoidable hospital readmissions, government regulators are monitoring how many Medicare patients suffering from three ailments — heart failure, heart attacks and pneumonia — were readmitted within 30 days of their release.

How a hospital compares to the national average, once risk factors are taken into consideration, determines whether it will face a reduction in payments from Medicare, the government insurance program that covers senior citizens.

In 2010, about one in five Medicare patients was readmitted to a hospital within 30 days of their initial stay, according to CMS. That cost the program $17.5 billion — a sum the government hopes to trim by making it financially advantageous for hospitals to find ways to prevent readmissions.

When the program began last year, the maximum penalty was 1 percent of Medicare payments. That increases to 2 percent this year, and will reach 3 percent in fiscal year 2015.

Carilion officials said the move to reduce readmissions is consistent with their ongoing efforts to improve patient care. Converting to a clinic model, which offers multi-specialty physician services as opposed to just running a chain of hospitals, was key part of that initiative, they said.

“I don’t look upon this as a cost,” Dr. Wayne Gandee, chief medical officer for Carilion, said of the penalty program.

“I look at it as an investment in the care of patients.”

Based on historical averages, Carilion lost an estimated $267,000 in Medicare payments during the first year of the program. Looking forward, that amount is expected to drop to $179,000 in the year starting Oct. 1, according to Don Halliwill, the health system’s chief financial officer.

Carilion officials said the reduction in penalties, which comes even as the potential punishment doubles, is a testament to their success in reducing readmissions.

For a health care system that had $1.3 billion in revenues during the most recently completed fiscal year, $446,000 in lost Medicare payments might not sound like a lot.

But Medicare is one of the biggest payers to hospitals, “so any cut to reimbursements can add up to a lot,” said Chris Bailey, senior vice president of the Virginia Hospital and Healthcare Association.

While the association supports the government’s efforts to reduce readmissions, it has some concerns about the process.

For example, a provider can be held responsible for a readmission if a heart attack patient goes back to a hospital within 30 days of their release, even if it’s for something totally unrelated to their first stay, such as injuries from an automobile accident.

“This is a fairly blunt instrument that could use significant refinement,” Bailey said.

Another criticism is that the program unfairly punishes hospitals that treat the largest number of low-income patients.

Those patients are more likely to come from communities where there’s less access to transportation, pharmacies and other services needed for a speedy recovery.

“Hospitals want to be held accountable,” said Akin Demehin, senior associate director of policy for the American Hospital Association. “But on the other hand we think it’s unfair that hospitals are being held accountable for community-based factors that, at the end of the day, are very difficult for us to control.”

At LewisGale, a spokeswoman said that while the Centers for Medicare & Medicaid Services has ranked the four hospitals among the best in the nation for the three conditions measured by the program — heart attacks, heart failure and pneumonia — there’s always room for improvement.

“We certainly view this as an opportunity to improve on our readmission rates,” spokeswoman Joy Sutton said. “This data is several years old and since that time we’ve implemented several new initiatives. As a result, we’ve already noticed an improvement in our readmission rates based on our own tracking process for our hospitals.”

LewisGale declined to say how much money it has lost in Medicare payments under the program.

“These new initiatives have focused on helping our patients become more compliant with discharge instructions and medication compliance as well as working with key community partners, such as nursing homes, to share discharge information on our patients to ensure appropriate follow up care,” Sutton said in a prepared statement.

Two hospitals in the region owned by Carilion, in Giles County and Lexington, are reimbursed by Medicare under a different system and did not fall under the penalty program.

At Roanoke Memorial, the most recent readmission rate for heart attack patients was 18.1 percent, slightly below the national average. The readmission rate for heart failure was also below the average.

“We started out pretty good,” Carilion spokesman Eric Earnhart said. “And we’re getting better.”

http://www.roanoke.com/living/health/2139010-12/medicare-penalties-hit-hospitals-in-roanoke-new-river.html

Hospitals address readmit penalties

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.

jbuchanan@record-journal.com (203)317-2230 Twitter: @JBuchananRJ

http://www.myrecordjournal.com/southington/southingtonnews/2037665-129/hospitals-address-readmit-penalties.html