By Jordan Rau
KAISER HEALTH NEWS
In the fall, the federal government will begin penalizing more than 2,000 hospitals, including dozens in the Philadelphia area, because too many of their patients are being readmitted within a month of being discharged.
Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins in October a wide-ranging – and much debated – push to pay providers based on the quality of care they give.
Nearly one in five Medicare patients is readmitted within a month, which the government considers a prime symptom of an overly expensive and uncoordinated system. Hospitals, critics say, have had little incentive to ensure that patients get the care they need once they leave, and even benefit financially when patients quickly return for more treatment.
The penalties are based on the frequency with which Medicare patients suffering from heart failure, heart attack, and pneumonia were readmitted within 30 days between July 2008 and June 2011. Medicare took into account how sick the patients were when calculating whether the rates were higher than those of the typical hospital, but not their racial or socioeconomic background.
Hospitals say that, in recent years, they have embraced new programs to reduce readmissions through intensive follow-ups, coordination with pharmacists and family doctors, and in-home services. Such programs are in effect at Cooper University Hospital in Camden, which is being penalized nearly the maximum 1 percent for its readmissions.
In a statement, Cooper noted that hospitals are faulted even if the readmission is for a problem unrelated to the original admission, or even if the readmission is to a different facility “and the original facility/physician isn’t aware.”
Nearly two million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare an additional $17.5 billion. The nation’s average readmission rate has held steady at just over 19 percent for several years, even as many hospitals have worked harder to lower theirs.
Starting Oct. 1, the penalty 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 submitted a claim for $20,000 for a surgical stay, Medicare would deduct $200 and reimburse $19,800.
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