One hospital readmission penalty by the numbers: .6 percent (or $312,000)

October 9, 2012 8:38 am by Gordon, Jennifer | 0 Comments

Heartland Regional Medical Center numbers among 2,217 hospitals across the country is to be penalized by the Centers for Medicare and Medicaid Services.

As part of health care reform, CMS is cracking down on hospital readmission rates. Medicare's Hospital Readmission Reduction Program, which took effect Oct. 1, will fine hospitals up to 1 percent of their Medicare funding if their readmission rates are higher than average.

Heartland was originally slated to lose .54 percent of its Medicare funding, about $300,000, but CMS recently discovered it made an error in its calculations. Heartland will now lose .59 percent of its funding, about $312,000, said Dr. James McMillen, a physician administrator for the Community Health Improvement Solutions.

CMS derived Heartland's .59 percent penalty from readmissison data collected between June 2008 to July 2011. But the loss in funding will not affect Heartland's services, Dr. McMillen said.

"We're not taking care away from anyone," he said.

Many hospital systems disagree that the amount of readmissions reflects the quality of an organization. A large research center might have a high number of patients returning because of the complexity of their case.

Dave Dillon, vice president of media relations for the Missouri Hospital Association, said the association is concerned about the monetary penalty.

"There's some fear that if you start using penalties for readmission, resources that would otherwise go to enhancing the quality of care will be spent on fighting readmissions, rather than other tactics that will be more beneficial," he said.

He said the hospital association also would prefer to see a readmissions policy that takes into account the socioeconomic status of the community it serves. Patients may not be able to afford their medications. They might be discharged and then return to an environment that's not going to help them recover, he said.

Heartland has looked at ways to reduce the number of newly discharged patients who re-enter the hospital for several years, Dr. McMillen said. It tracks patients who are more likely to return to the hospital through a system it calls "LACE."

Caregivers use LACE to calculate the likelihood the patient will be readmitted by looking at length of stay, level of acuity at admission, comorbidity and emergency room visits in the past six months. Scores higher than 11 will be monitored more closely by a care manager.

Dr. McMillen sees Heartland's penalty this year as a push to tweak its system.

"Obviously, we want to minimize all the penalties that we can, and I think this is an impetus to be as sharp as we can," he said.

Currently, there is no system in place that acknowledges hospitals that lower their readmission rates.

Jennifer Gordon can be reached

at jennifer.gordon@newspressnow.com. Follow her on Twitter: @jjgordon. ___

Visit the St. Joseph News-Press (St. Joseph, Mo.) at www.newspressnow.com/index.html

Distributed by MCT Information Services