Medicare To Punish 24 Connecticut Hospitals For High Readmissions

August 6, 2013
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Twenty-four of Connecticut’s 31 hospitals will face Medicare penalties in the fiscal year starting in October, in the second round of the federal government’s push to reduce the number of patients readmitted within a month of discharge, new data shows.

None of the state’s hospitals will lose the maximum amount possible – 2 percent of every Medicare payment for a patient stay — which is double this year’s penalty. But three will lose more than 1 percent. The Hospital of St. Raphael, which is now merged with Yale-New Haven Hospital, will lose 1.77 percent; the Masonic Home and Hospital in Wallingford will lose 1.14 percent; and St. Vincent’s Medical Center in Bridgeport will lose 1.06 percent.

Statewide, Connecticut’s hospitals face an average penalty of .43 percent of Medicare funds, which is higher than the national average. Hospitals in 12 states, including Massachusetts and Rhode Island, face higher average penalties.

Hospital administrators in the state say they have made myriad efforts to reduce readmissions in the past two years, and they note that the new penalties are based on readmissions through June 2012. Medicare counts patients who originally went into the hospital with at least one of three conditions — heart attack, heart failure or pneumonia—and landed back in the hospital within 30 days for any reason, even if it was unrelated to the original stay.

Nationally, about 20 percent of hospitalized Medicare patients are back within 30 days, at an estimated cost of $17 billion a year, according to the Medicare Payment Advisory Commission.

At Yale-New Haven Hospital, efforts to reduce readmissions, especially for heart failure patients, have focused largely on improvements in discharge planning, said Dr. Thomas Balcezak, senior vice president of patient safety and quality.

“We’re working on making sure every patient gets a ‘warm handoff’” that includes clear discharge instructions on medication, follow-up appointments and continuing care. Some elderly patients receive help from ‘patient navigators’ in securing proper services after discharge, under a grant program that Yale is piloting.

Yale-New Haven acquired the Hospital of St. Raphael last September, and the two hospitals had different readmission results in 2012. Yale faces a Medicare penalty of .51 percent in the coming year – less than this year’s .90 percent penalty. But St. Raphael’s penalty went up – from the maximum 1 percent last year, to 1.77 percent in the new fiscal year, the highest in the state.

Balcezak said efforts have been underway since the acquisition to merge and align the two hospital’s policies and operations – moves he said may help to reduce readmission rates for both hospitals. Recently, the two campuses adopted one electronic medical records system, so that information can be shared more easily among clinicians.

Hospital experts have noted that so-called safety net hospitals, which treat large numbers of low-income people, tend to have higher readmission rates. Some experts have recommended that the readmission penalties take into account the socio-economic status of patients.

Nationally, 2,225 hospitals will have Medicare payments reduced starting on Oct. 1, according to an analysis by Kaiser Health News. Eighteen hospitals will lose the maximum 2 percent, while about 150 will lose 1 percent or more.

In Connecticut, seven hospitals will face no penalties. They are: Stamford Hospital, Rockville General, New Milford, Middlesex, Manchester Memorial, Day Kimball in Putnam, and the Hebrew Home and Hospital in West Hartford.

Facing fines higher than the national average are: Bristol Hospital (.85 percent); Greenwich Hospital (.41 percent); Griffin Hospital in Derby (.97 percent); MidState Medical Center in Meriden (.78 percent); Milford Hospital (.76 percent); and St. Francis Hospital & Medical Center in Hartford (.39 percent). The other state hospitals will face lower penalties, including Lawrence & Memorial in New London, which will lose .13 percent of every Medicare payment for a patient stay; Bridgeport Hospital (.2 percent); Hartford Hospital (.1 percent); and Charlotte Hungerford in Torrington (.04 percent).

Fourteen state hospitals will face lower penalties than they did in the last year, with the biggest percentage point drops at Yale-New Haven, John Dempsey Hospital in Farmington, Saint Mary’s Hospital in Waterbury, Johnson Memorial Hospital in Stafford Springs, MidState and Danbury Hospital.

Readmission penalties are among a number of financial pressures weighing on hospitals in Connecticut and nationally. The federal government also is squeezing hospitals to reduce unnecessary inpatient stays, which has led to the controversial use of “observation status” as an alternative to admission. Patients who are deemed to be on observation status during a stay are not counted as admissions, but find themselves without Medicare coverage for nursing home care after discharge. That policy is being challenged in a lawsuit in federal court in Hartford.

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