Hospitals Get Handle On Patient Readmissions
When hospital executives learned they could see a cut in their Medicare reimbursements over preventable patient readmissions, they were anxious. After all, Medicare is the single largest payer in the U.S. health care system.
The readmission penalties, which are issued by the Centers for Medicare and Medicaid (CMS), are based on the number of patients readmitted within 30 days of treatment for heart attacks, heart failure and pneumonia between 2009 and 2012. They were first implemented in fiscal 2013, which ended Sept. 30, and levied a 1-percent maximum penalty on reimbursements. In fiscal 2014, that levy was doubled.
But many hospitals sidestepped a larger penalty in the new fiscal year, and the average penalty for hospitals nationwide dropped in fiscal 2014, according to an analysis published in August by Kaiser Health News, part of the Kaiser Family Foundation. Kaiser found that the average penalty in fiscal 2014 is 0.38 percent of Medicare reimbursements, down from 0.42 percent in fiscal 2013. In all, the government levied $53 million less in penalties nationwide this year.
Central Massachusetts is no exception. Most hospitals in this region were hit with smaller Medicare penalties this year, according to Kaiser. That includes reduced fines for four out of the five UMass Memorial Health Care hospitals; Saint Vincent Hospital in Worcester and MetroWest Medical Center in Natick and Framingham, both owned by Tenet Health Systems; as well as Harrington Memorial HealthCare in Southbridge, Heywood Hospital in Gardner and Nashoba Valley Medical Center in Ayer.
The two hospitals that saw hikes were Milford Regional Medical Center and UMass Memorial’s HealthAlliance Hospital in Leominster.
According to Massachusetts hospital officials, executives have responded to the threat of penalties proactively, implementing measures aimed at slashing preventable readmissions. Officials at the Massachusetts Hospital Association (MHA) said shrinking penalties confirm those measures are effective.
Linking Projects To Reduce Readmissions
“There are many, many linking projects going on, really trying to help reduce the rate of readmissions,” said Pat Noga, vice president for clinical affairs at MHA. “I think — little by little — we’re beginning to see some of our quality improvement efforts taking effect. So I think some of it certainly is related to some of these efforts, and I think over time, you'll see more.”
MHA has provided leadership in this arena, creating an initiative that most Bay State hospitals signed onto in 2009, Noga said. The program, State Action on Avoidable Rehospitalizations, or STAR, focuses on reducing readmission through improved communication with home-care providers and physicians; teaching patients about post-acute care upon release; ensuring timely followup on patients after they’re released from the hospital; and identifying chief factors that lead to readmissions.
In the Greater Worcester area, hospitals and physicians have participated in regional efforts to combat readmissions, too, according to Noga. Examples of those efforts include education for physicians and patients on end-of-life care and collaboration among hospitals, doctors and nurses to provide home-care support for patients.
Government Learning Too?
But the actions hospitals have taken to combat readmissions probably don't tell the whole story. Tim Gens, executive vice president at MHA, noted that CMS has revised how it calculates readmissions to determine penalties. For example, planned readmissions for procedures after initial treatments were used to calculate the fiscal 2013 penalties, but those were eliminated in this year's formula.
“Those on the government side are learning just as hospitals are,” Gens said.
Hospitals that saw their penalties increase may be at the mercy of the particulars of the patient populations they serve. For example, hospitals that treat a higher proportion of low-income patients are more likely to have higher readmissions and penalties.
But in some cases, hospital executives are stumped by the problem of readmissions. Milford Regional, for instance, saw its penalty increase from 0.42 percent of Medicare reimbursements in fiscal 2013 to 0.88 percent in fiscal 2014, despite implementing the same types of readmission-reduction efforts, Noga cited.
Annette Roberts, director of quality at Milford Regional, said discharged patients work with care managers to ensure adequate followup, and the hospital has partnerships with skilled nursing facilities to provide patients with adequate home care after they’re released.
Roberts said those efforts will continue, but finding out how to effectively curb readmissions is a “tricky, tricky area.”
It may be the case that hospitals are playing catchup. Since the current Medicare penalties are based on readmissions between 2009 and 2012, any newer efforts to reduce readmissions have yet to be reflected in penalties. UMass Memorial Health Care, for example, launched a systemwide program at the end of 2012 called Transitions of Care (TOC). Spokesman Robert Brogna said in an e-mail that TOC seeks to reduce readmissions through measures like discussing post-hospital treatment plans with family members, scheduling follow-up appointments before a patient is discharged, and making all records available to physicians following discharge. Brogna said the program was piloted at UMass hospitals throughout 2012 before it was fully launched in December.
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