Hospitals penalized for readmissions

By Frank Lewis

[email protected]

Two Portsmouth hospitals are among the 2,592 hospitals in the U.S. to be penalized by Medicare for having patients frequently return within a month of discharge. According to Kaiser Health News, this time, the reductions total $420 million across the country.

King’s Daughters Medical Center Ohio will be docked the maximum amount of 3 percent in 2016, while Southern Ohio Medical Center will be assessed 0.95 percent.

“The proposed rule for King’s Daughters Ohio indicated there would be no penalty but the final rule changed and we (are) unsure as to the difference,” Elaine Corbitt, a spokesperson for KDMC, told the Daily Times. “As the final rule was just published on July 30 we’ve just started evaluating the data.”

The Times received the following response from SOMC.

“It is our goal to maintain low readmission rates at Southern Ohio Medical Center – not because of its affect on reimbursements, but because we believe it is better for our patients.”

Some hospitals view the punishments as unfair because they can lose money even if they had fewer readmissions than they did in previous years. A Kaiser Health News analysis of the records found all but 209 of the hospitals penalized in this round were also punished last year.

The records from KHN show that while KDMC Portsmouth was not assessed in the previous three years, SOMC was assessed 0.27 percent in 2013, 0.05 percent in 2014, and 1.05 percent in 2015.

“The latest data shows that SOMC has made progress in this area. Our Medicare reimbursement for 2016 will be impacted by 0.95 percent, or approximately $60 per Medicare patient,” SOMC said in their response. “Hospital readmission rates are sometimes affected by factors that are uncontrollable or even unrelated to a patient’s original reason for seeking care. Navigating these factors is a challenge all hospitals face, and one we are happy to accept as part of our ongoing effort to provide exceptional patient care.”

According to KHN, 2,592 hospitals will receive lower payments for every Medicare patient that stays in the hospital, readmitted or not, starting in October. The Hospital Readmissions Reduction Program, created by the Affordable Care Act (ACA), was designed to make hospitals pay closer attention to what happens to their patients after they get discharged.

KHN says, since the fines began, national readmission rates have dropped, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month.

The fines are based on readmissions between July 2011 and June 2014 and include Medicare patients who were originally hospitalized for one of five conditions: heart attack, heart failure, pneumonia, chronic lung problems or elective hip or knee replacements.

Reach Frank Lewis at 740-353-3101, ext. 1928, or on Twitter @franklewis.

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