4 hospitals' Medicare penalties rising because of readmission rates

4 hospitals' Medicare penalties rising because of readmission rates

URBANA — Four East Central Illinois hospitals face higher penalties from Medicare in the year ahead because they have too many patients who wind up back in the hospital within a month after being discharged.

Presence Covenant and United Samaritans medical centers, Carle Foundation Hospital and Sarah Bush Lincoln Health Center are all losing a percentage of their payments on Medicare inpatient stays from Oct. 1 of this year through Sept. 30, 2015.

The fines are based on three years' worth of readmission data for five categories of treatment, and are aimed at cutting down the number of patients who are readmitted to hospitals for care within 30 days of being discharged.

Readmissions drive up the health care costs for patients and insurers, and the number of readmissions nationally has been on a decline recently, the Centers for Medicare and Medicaid Services said.

Total readmissions fell by about 150,000 from January 2012 through December 2013, the agency said.

This year, 2,610 hospitals — about three-fourths of those subject to Medicare's readmissions reduction program — are being penalized, according to federal records compiled by Kaiser Health News. In Illinois, 118 hospitals face penalties averaging 0.78 percent, the Kaiser analysis found.

Some that are exempted include critical-access hospitals, among them Kirby Medical Center, Carle Hoopeston Regional Health Center and Gibson Area Hospital, as well as some cancer hospitals.

The cost of the penalties for Presence Health's hospitals in Urbana and Danville will total about $750,000 on projected Medicare payments for the year, said interim CEO Dr. Jared Rogers.

Carle stands to lose about $200,000, and Sarah Bush Lincoln's penalty is projected to run $288,800, officials at those hospitals said.

Penalties for the two Presence hospitals aren't "significant to the point that it threatens anything," Rogers said. "It just makes things more difficult."

One factor behind the increased penalties is two new readmissions measures — those for patients readmitted after knee or hip replacements and chronic obstructive pulmonary disease — according to Rogers. Those two measures were added to three others already being targeted by Medicare — pneumonia, heart-attack and heart-failure readmissions.

Medicare looked at cumulative readmissions from July 1, 2010, to June 30, 2013, for this third penalty cycle, Rogers said.

Cutting down on those readmissions is a laudable goal, Rogers said, but he also thinks Medicare's new measures may not be fully realistic for today's patients. With growth in outpatient services, hospitals today care for the sickest patients, and some of these patients are living longer with chronic conditions, he said.

"There are things changing that I don't think are being taken into consideration," Rogers said.

Carle Chief Quality Officer Dr. Robert Healy said any financial loss is going to affect the hospital.

"But of course, what it represents is more important," he said. "Patients being readmitted is a measure of how well we're treating them."

Healy said efforts to reduce readmissions at Carle have focused on more than what Medicare is measuring, and Carle has achieved some dramatic reductions in readmissions for heart attack and heart failure.

In recent months, readmissions to Carle for heart failure have been cut in half, he said.

Reductions have been achieved through such changes as treating those patients with a team approach, assessing patients before they leave the hospital and sending a nurse to their homes after discharge, Healy said.

Cutting down on readmissions requires a multiple-angle approach that includes making sure the appropriate treatments are given at the hospital, discharge instructions are communicated well and patients are followed up with, Rogers said.

To help reduce readmissions, the two Presence hospitals have participated in a national initiative led by the Society of Hospital Medicine to improve the care of patients in their transition from hospital to home called Project BOOST, he said.

Some factors are beyond a hospital's control, he said. Sometimes patients who wind up back in the hospital lacked a ride to see their doctors or couldn't buy their medicine, and those things aren't communicated to the hospitals, Rogers said.

So both Presence hospitals are focusing on a more comprehensive approach that includes social and economic factors behind readmissions along with the medical ones, he said.

Sarah Bush Lincoln Chief Financial Officer Dennis Pluard said the new readmissions measures likely affected the increased penalty at Sarah Bush Lincoln.

"We have four very active orthopedic surgeons, and they do a lot of joint replacements, and good or bad, those do require a lot of readmissions," he said.

Sarah Bush Lincoln is also focusing on more than the five Medicare measures, he said.

"We will do what we need to do to bring that $288,000 down, and we have a number of quality initiatives in place that will help with that," he said.

Among them has been increasing the number of physicians who see patients in the hospital, Pluard said.

Sarah Bush Lincoln is also offering patients who have been readmitted some exercise and nutrition and lifestyle coaching at a healthy living center and has stepped up communications between the hospital pharmacy and patients, according to Sarah Bush Lincoln spokeswoman Patty Peterson.

A pharmacist sees patients before they leave to deliver prescriptions and explain the importance of taking the medication, and some home deliveries of medicines are being made for patients who haven't complied with medication instructions, she said.

The pharmacy has also cut the prices on some commonly used prescriptions to make them more affordable, Peterson said.

"That's one of the reasons people end up back in the hospital," she said. "They don't take the medicines."

How much are they losing?

Here are the percentages Medicare is trimming from its payments for inpatient visits at East Central Illinois hospitals as penalties for excess readmissions:

-- Presence Covenant Medial Center: 0.50% in 2014; 1.38% in 2015.

-- Presence United Samaritans Medical Center: 1.64% in 2014; 1.74% in 2015.

-- Sarah Bush Lincoln Health Center: 0.04% in 2014; 1.66% in 2015.

-- Carle Foundation Hospital: 0.16% in 2014; 0.32% in 2015.

-- Iroquois Memorial Hospital: 0% for both years.

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