Twenty-nine Kansas hospitals will be penalized by the government starting in October because their Medicare patients were readmitted too soon after discharge, according to a recent analysis by Kaiser Health News.
Lawrence Memorial Hospital is not one of them.
“I think we have taken a proactive and a collaborative approach,” LMH President and CEO Gene Meyer said of reducing its readmission rates.
He said doctors, nurses and social workers work together and then coordinate with area agencies to ensure the patient is taken care of once he or she returns home.
LMH receives about $60 million annually in Medicare reimbursements, and it likely won’t lose any of it because of the new penalties that are being implemented as part of the Affordable Care Act’s Hospital Readmissions Reduction Program.
Nearly one in five Medicare patients, or 2 million beneficiaries, are readmitted within 30 days of release each year, costing Medicare $17 billion in additional hospital bills, according to Kaiser Health News. The national average readmission rate has remained steady at slightly above 19 percent for several years, and that’s because hospitals have had little financial incentive to ensure patients received the care they needed once they left. That is until the Affordable Care Act, also known as health reform or Obamacare, was passed.
Beginning Oct. 1, hospitals can lose up to 1 percent of their base Medicare reimbursements. The penalties will be deducted from reimbursements each time a hospital submits a claim. For example, if a hospital received the maximum penalty of 1 percent and it submitted a claim for $20,000 for a stay, Medicare would reimburse it $19,800. The maximum penalty will increase to 2 percent in October 2013, and then it will increase to 3 percent the following year.
The penalties are based on the frequency that Medicare heart failure, heart attack and pneumonia patients were readmitted within 30 days between July 2008 and July 2011.
Kaiser analyzed hospital readmission records nationwide and released its findings last week. It found:
• 2,211 — hospitals nationwide will be penalized a total of $280 million in Medicare funds.
• 278 — hospitals will lose the maximum amount.
• 29 — Kansas hospitals will be penalized.
• 2 — Kansas hospitals will lose the maximum amount. They are Coffey County Hospital and Morton County Hospital.
Kaiser Health News estimated that Kansas University Hospital would face a penalty of .38 percent for its readmission rate.
Dr. Lee Norman, KU Hospital senior vice president and chief medical officer, said the estimate was in line with the hospital’s estimates, which means they would lose about $360,000 a year. KU Hospital receives about $75 million annually in Medicare reimbursements.
Norman said KU Hospital has worked to reduce readmission rates in a number of ways. Among them is a new “huddle concept” where the doctors, nurses, pharmacists, therapists and case managers meet briefly once a day to discuss each patient.
“This huddle concept is incredibly powerful for getting everybody on the same page with the family and with the patients,” he said.
Norman said they also try to identify early on the patients who are higher risk of readmission. Often, these are patients who have multiple conditions or lack support at home.
Norman, who has been a doctor for more than 30 years, said medicine is one of the leading causes of readmissions. He said patients either don’t understand their medications or they just don’t have the money to buy them.
“Patients are proud. They don’t want to tell their nurses and doctors that they don’t have the money to pay for the medication when they get home,” he said.
So, KU Hospital staff focus on educating the patients before they leave and often follow up once they are home.
“I personally think that paying for performance and paying for quality is the way to go,” Norman said. He pointed out that the readmission rate is just one measure, but there are other measures where KU is getting paid more because they are meeting or exceeding standards. “We have been very successful through the years of getting to the top of performance measures in terms of quality.”
KU is among the top 20 percent of academic hospitals nationally when it comes to taking care of patients with complicated cases.
“That’s an elite, select kind of patient that unfortunately is more likely to be readmitted,” Norman said. “I just hope it doesn’t penalize us to a point where we worry about our mission. To this point, we are not anywhere close to that.”
— Kaiser Health News contributed information to this story.
Kaiser Health News recently released its analysis of the penalties hospitals could be facing because too many Medicare patients were readmitted within 30 days of discharge. The maximum penalty amount is 1 percent of their base Medicare reimbursements. Here’s how hospitals fared in the Lawrence region:
• Providence Medical Center, Kansas City, Kan. — 0.79 percent.
• St. Luke’s Hospital of Kansas City, Mo. — 0.52 percent.
• Shawnee Mission Medical Center — 0.45 percent.
• Kansas University Hospital — 0.38 percent.
• Menorah Medical Center, Overland Park — 0.37 percent.
• Saint John Hospital, Leavenworth — 0.33 percent.
• St. Luke’s Hospital South, Overland Park — 0.31 percent.
• Overland Park Regional Medical Center — 0.15 percent.
• Ransom Memorial Hospital, Ottawa — 0.13 percent.
• Cushing Memorial Hospital, Leavenworth — 0.02 percent.
The following would receive no penalties: Lawrence Memorial Hospital, Olathe Medical Center, St. Francis Health Center of Topeka, and Stormont-Vail Healthcare of Topeka.
For a complete list, visit kaiserhealthnews.org.