Janesville46.6°

Medicare penalties won't hit county's hospitals

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Jim Leute
October 5, 2012

— Wisconsin hospitals—including all in Rock County—fared well in a new performance review and will be fully reimbursed for their Medicare services.

The provision, enacted under the Affordable Care Act, penalizes hospitals for excessive Medicare readmissions for three medical conditions: heart attacks, heart failure and pneumonia.

The maximum amount a hospital can be penalized is 1 percent of its Medicare payments.

That will increase to 2 percent in 2013 and 3 percent in 2014. The penalty focuses on patients who return to a hospital within 30 days of their discharge because of complications.

The penalties are part of a broad push under President Barack Obama's health care law to improve quality while also trying to save taxpayers money.

Starting Oct. 1, about two-thirds of the hospitals serving Medicare patients—some 2,200 facilities nationwide—will be hit with penalties averaging around $125,000 per facility, according to government estimates.

In Wisconsin, the government looked at the readmission records of 65 hospitals. Sixty percent will face no penalty, while 40 percent will face penalties ranging from 0.01 percent to 0.49 percent.

"The good news for Wisconsin is that we have among the lowest rates of readmitting patients to the hospital in the country," Wisconsin Hospital Association President Steve Brenton said.

Brenton noted that among states with more than 20 hospitals subject to the new provision, Wisconsin was fifth lowest in penalties and performed better than the neighboring states of Illinois and Minnesota.

In advance of the potential penalties, many hospitals worked to improve communication with rehabilitation centers and doctors who follow patients after they're released.

They've also tried to make better individual connections with the patients they discharge.

Those aren't new concepts at Mercy Hospital and Trauma Center, said Ruth Yarbrough, vice president of Mercy Health System.

Yarbrough said the Janesville hospital has long focused on preventing unnecessary readmissions. The key to that, she said, is the coordination of patient care throughout the entire system, which includes 68 facilities in 26 communities in southern Wisconsin and northern Illinois.

"Coordination of care is a key element of Mercy's integrated approach to providing health care in the communities Mercy serves," she said.

Yarbrough said patient education is important in reducing readmissions.

"We work with patients throughout a hospital stay to make sure patients understand their diagnosis and what they must do to stay healthy at home," she said. "At the time of discharge, we review patient instructions and medication lists to make sure patients have a good understanding as they go home."

A Mercy nurse calls each patient within two or three days of discharge to check on his or her status and help find resources if the patient needs help.

Yarbrough said Mercy's system of electronic medical records has integrated patient information that helps in both diagnosis and treatment.

In addition, Mercy has classes for patients being admitted for planned procedures such as joint replacement surgery. They learn what to do before, during and after their stay.

"These classes give patients timely information thus contributing to a better understanding of their care," Yarbrough said.

Mercy also participates in the Wisconsin Hospital Association "Partnership for Patients" program that allows hospitals to share best practices.

The association's program works with 67 hospitals to strengthen the relationship between hospital staff members and patients. Each month, the hospitals come together for quality improvement training and to learn which interventions are most effective in reducing hospital readmissions.

Industry officials still say they have misgivings about being held liable for circumstances beyond their control. They also complain that facilities serving low-income people, including many major teaching hospitals, are much more likely to be fined, raising questions of fairness.

While Wisconsin hospitals are doing well, Brenton said they can only go so far.

"The impact a hospital can have on a patient's successful recovery is limited once they leave the hospital," Brenton said. "This reality is why WHA repeatedly expressed concerns that Congress and the administration must focus the policy on avoidable readmissions. Unfortunately, the final policy did not do so.

"Regardless, we are pleased to see that Wisconsin hospitals perform well even under an approach that needs more refinement."

Later this month, the CMS plans to post hospital-specific details online so people can see how their community hospital performed.

Material from The Associated Press was used in this story



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