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Area Hospitals Soon To Be Penalized For High Readmissions Rates

Elana Gordon

Starting October 1, hospitals that fail to meet certain quality measures will get less funding from Medicare.

Specifically, places that have worse-than-average readmission rates for certain medical conditions will receive lower reimbursements for services. Several area hospitals will be affected, including some that one might not expect. They’ve been keeping close watch on the upcoming changes, though many disagree with them.

“I would venture to say this is probably the biggest and certainly one of the first real ties between payments in Medicare and delivery of quality,” says Dave Dillon, a spokesperson with the Missouri Hospital Association who has reservations about the new penalties.

Dillon says hospital readmissions have been an issue for years, despite efforts to curb them. The idea of the penalties is to change that with more financial push.

“There would be the assumption I think – at least there probably during the development of this as quality measure and during the implementation process of this as a rule – that if you can reduce with the 30 day readmission for an individual that has heart attack, heart failure or pneumonia, then you’re providing them the type of care they need when they’re in the hospital and you’re providing them with the tools they need at discharge to not come directly back to the hospital within 30 days,” says Dillon.

Effective next week, under the federal health law, hospitals will face up to a one percent reduction in their Medicare payments, depending on their past readmissions rates for patients returning to the hospital within thirty days. The penalty cap rises to three percent by 2015. As it stands, caring for those Medicare patients costs the program about $17.5 billion. The new penalties will amount to about $278 million in the first year, so the fiscal impact on hospitals may vary. 

Nationwide, more than 2,000 hospitals will be facing penalties, according to a Kaiser Health News analysis. Included on the list are more than two thirds of hospitals in Missouri and about half of hospitals in Kansas.

See a list of hospitals in Kansas and Missouri and the penalties they’ll face here.

Shauna Roberts is with Truman Medical Center, an area hospital that sees a lot of people without insurance or a means to pay. She says Truman’s upcoming penalty will be pretty low, but it still caught their attention.

“That’s like a C minus on your grade card, and nobody wants that,” says Roberts. “I think that they are forcing us to take a hard look at some things we’ve needed to see differently.”

Nearly three hundred hospitals across the country will be receiving the maximum penalty. St. Mary’s Hospital in Blue Springs, part of the Carondelet health system, almost reached that level.

Annette Small, CEO of St. Mary’s, says keeping patients out of the hospital is optimal, and they’re having success with some pilot programs. But Small worries about using 30 day readmissions data to gauge overall hospital quality, especially when a lot more may be at play in why patients return to the hospital, beyond the care they get.

“That’s a little challenging to juggle,” says Small. “So how do we get our arms wrapped around that because of all the mitigating factors involved, some of which aren’t in our control?”

Small says readmissions may depend on how sick or vulnerable patients are, the type of care they then get in the community and whether they’re following recommendations.  Dillon, with the Missouri Hospital Association, shares these concerns. As does Dr. Lee Norman, chief medical officer at the University of Kansas Hospital. The hospital, ranked the highest in the region according to U.S. News and World Report, is also getting a penalty.

“I mean this is a web, a network that requires really good systems of care,” says Norman. “Penalties are blunt instruments, just to say hospital do everything you can, in the meantime we’re going to penalize you for something that quite possibly might be out of your control.”

Even so, he says the new measures have hospitals considering a new role, one that goes beyond the doors of their facilities.

“I mean,we can do so much, but ultimately the patient goes home or the patient goes some place, and we really have to partner with the patient and their families. We’ve always done that and we’ve always wanted to do that.  But it’s a little bit of a game changer then when there’s financial penalties for something that’s maybe completely out of the hospital’s control.”

Norman says everyone has a stake in this: insurance companies, the government, neighborhoods. And while he says singling out hospitals may not be the right approach, you’ve got to start somewhere.


This story is part of a reporting partnership that includes KCUR , NPR and Kaiser Health News.


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