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Metro, Spectrum subject to Medicare readmission penalties
Hospitals are trying to reduce readmission rates to comply with Affordable Care Act.
Another aspect of the Patient Protection and Affordable Care Act kicked in with the start of the new federal fiscal year on Oct. 1, when Medicare began penalizing hospitals that have certain types of Medicare patients who are discharged and then readmitted too soon, too often.
Medicare looked at the frequency of heart failure, heart attack and pneumonia patients who were readmitted due to complications within 30 days, between July 2008 and June 2011. According to Kaiser Health News, almost 2 million Medicare beneficiaries — about one in five — are readmitted within 30 days of release each year, costing Medicare more than $17 billion in additional expenses. The government believes that readmission within a month is an indication that those hospitals can be doing more to ensure that patients receive the care they need after they are discharged.
During the 2013 federal fiscal year, the maximum penalty allowed under the federal law is 1 percent of the hospital’s base Medicare reimbursements. According to a KHN analysis of data from the Centers for Medicare & Medicaid Services, two of four Spectrum Health System hospitals are subject to the penalty, as is Metro Health.
Spectrum’s United Memorial Hospital in Greenville is subject to a penalty of 0.46 percent, and Spectrum’s Gerber Memorial in Fremont is subject to 0.02 percent. Bruce Rossman, a spokesman for Spectrum, said the total amount in cash is calculated to be “in the neighborhood of $20,000.”
Metro Health is subject to an estimated penalty of 0.19 percent, which hospital spokesperson Ellen Bristol said is thought to equal approximately $88,000.
Saint Mary’s Health Care in Grand Rapids has no penalty, nor do the two Mercy Health Partners facilities in Muskegon: Hackley Hospital and Mercy Hospital.
Seven Michigan hospitals are subject to the full 1 percent penalty; all are in southeast Michigan. A total of 92 Michigan hospitals were studied by CMS.
According to a recent issue of amednews.com, a publication of the American Medical Association, hospital administrators say the penalty for too many repeat Medicare patients “fails to account for socioeconomic factors and leaves poorer communities at a disadvantage.”
Dr. David Duffey, chief medical officer at Metro Health, said Metro’s goal is “not to have any unplanned readmissions, so we’ve been working toward that for quite a while. But it’s very difficult.”
Duffey emphasized that there are “a lot of other factors that sometimes feel out of the control of providers.” For example, he said, an issue would be whether or not the patient’s family complies with instructions from the hospital for use of the patient’s medications at home after discharge. Another would be whether or not there was an accident or illness that compounds the reasons for the patient’s first hospitalization.
Duffey said other health care systems with which he is in contact have been focusing on transition of care from one organization or setting to another. At Metro, he said, patients will be scheduled for appointments prior to discharge “so that we know that they have appropriate follow-up when they go home.” Some Metro nurses are assigned to call the patient’s home, after discharge, to make sure the patient’s recovery is continuing.
Metro has a list of home health care providers it recommends the discharged patient use, and a new program there is Home Care Connect, a free service in which a discharged patient has a device to use at home to immediately connect them with the hospital staff.
“That’s a free service for 60 days,” said Duffey.
At eight of Metro’s outpatient neighborhood centers, there are care managers assigned to help provide support for discharged patients with chronic illnesses “to make sure care is ongoing,” he said.
“We do keep a close eye on readmission rates” at Spectrum facilities, said Rossman.
He said Spectrum is “doing things to improve partnering” between hospital staff and primary care doctors in the community to improve access to follow-up care, “because primary care plays a big role in helping keep people out of the hospital.”
Readmission rates are something every hospital will need to watch closely in the future, added Rossman.
Lody Zwarensteyn, director of the Alliance for Health, said the readmissions controversy has been around a long time.
“The hospital community has known the Medicare folks would like to have something akin to a warranty on hospital work,” he said. “We’re hopeful that strategies can be developed to make sure that people don’t have to be readmitted.”
At one time, said Zwarensteyn, hospitals had a goal of discharging patients sooner to keep costs down, but now it is recognized that meeting that goal may leave some people more vulnerable to the need for readmission, he said.
The Alliance for Health has been working with a number of hospitals and long-term care institutions so that patients discharged from a hospital to a nursing home will received the post-hospital care they require.
“It’s a matter of quality and communications,” he said.
Kaiser Health News is produced by the Kaiser Family Foundation of Menlo Park, Calif. The foundation is a nonprofit private organization dedicated to producing and communicating the best possible analysis and information on health issues.