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  • Hospitals Expected to Forfeit $280 Million in Medicare Payments Due to Readmissions

    More than 2,000 hospitals, including some nationally recognized ones, will be penalized starting in October under the Affordable Care Act's Hospital Readmissions Reduction Program, says a Kaiser Health News  article. Together, these hospitals will forfeit about $280 million in Medicare payments over the next year for excess readmissions for heart attack, heart failure, and pneumonia.

    The penalties will be the most severe in hospitals in New Jersey, New York, the District of Columbia, Arkansas, Kentucky, Mississippi, Illinois, and Massachusetts. Hospitals that treat the most low-income patients will be hit particularly hard.

    A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law—1% of their base Medicare payments. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey; North Shore University Hospital in Manhasset, New York; and Beth Israel Deaconess Medical Center in Boston, the article says.

    The total number of hospitals receiving penalties is 2,211. According to Medicare records, 1,933 hospitals will receive penalties less than 1% percent. Massachusetts General Hospital in Boston, which has been rated as the best hospital in the country, will lose 0.5% of its Medicare payments because of its readmission rates.  

    Nearly 1 in 5 Medicare beneficiaries are readmitted within 30 days of discharge each year, costing Medicare 17.4 billion in additional hospital bills, according to a 2009 study on Medicare claims data from 2003-2004. The national average readmission rate has remained steady at slightly above 19%, even as many hospitals have worked to lower theirs, says Kaiser Health News

    Physical therapists can help serve an important role in patient care transitions and care coordination and can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions. For more information and to find clinical practice and patient education resources to reduce readmissions, visit APTA's Hospital Readmissions webpage


    • This has been a long time coming. In cases where reasons for readmit can be deduced from case manager, physician, or hospital facility management of the patient directly, it certainly applies. Essentially, in such cases, this represents a "failure" in the management of the patient's condition. Again, only if the outcome can directly be linked to the care of the patient, not patient-influenced or environmental-based factors.

      Posted by Dave Ravnikar, PT, DPT, CSCS on 8/18/2012 10:14 AM

    • I agree with you Dave. Unfortunately, the system is tainted to where corporations are only looking for the top dollar and don't care about what brings the patient back to the facility, be it a hospital, SNF, etc. Management just tells us to eval them and get them working simply because they are a new admission. This is a huge issue in PT and there will be many more than this in the near future.

      Posted by Jacquelyn Brenner, DPT on 8/23/2012 6:21 PM

    • Sounds like neither of you work in a hospital. Those readmissions are overwhelmingly caused by noncompliance when the patient goes home, the overall poor health of the patient anyway. Its not mismanagement of the patient. You can manage the patient extremely well and clear up the problem such as CHF,pneumonia, etc. But then the person goes home and doesnt follow the diet, continues to smoke, family cant handle them at home, etc. And they come back in with the same issue and the hospital is penalized. And if the hospital staff wants to keep the patient an extra day then medicare will count that against you because they have their expected length of stays that you need to adhere to for each diagnosis. And Jacquelyn, when a patient is readmitted to the hospital (which is what the article is talking about) and PT is asked to evaluate the patient noone is thinking about making any money off the patient. The reason is because PT, OT and ST services are not reimbursed in the hospital inpatient acute care setting at all. So if management wanted to save/make money they would not have PT to see them at all on acute settings and use PTs only in outpatient or on hospital inpatient rehab floors, or hospital based skilled nursing units. I appreciate some of what medicare is trying to do but dont punish hospitals because a patient comes back into their facility. It is almost always not the hospital's fault. All these decreased payments and RAC audits that are taking money back left and right are doing a good job of putting smaller hospitals right out of business. Which means less access to healthcare for the medicare patients in the long run.

      Posted by Pete B. OT/L Rehab manager on 10/3/2012 9:31 AM

    • Well, folks, it looks like those 2,000+ pages which is full of ways to limit Medicare and other medical payments, but according to the current administration , this won't affect care. When reimbursements continue to shrink hospitals that employ hundreds of people are going to have to lay people off, to stay afloat. Do you think that PT and other rehab services aren't going to be affected? Just like stroke patients in skilled nursing aren't admitted to hospitals, now cardiac arrests won't be sent to hospitals to be admitted, because of the penalties and the 15 member committee who will decide which patients will receive services and which will not be eligible due to age, or whatever criteria they decide in order to save money.

      Posted by Laura Sample Coykendall on 10/3/2012 10:09 PM

    • I agree that patient non-compliance will cause readmissions, but I also believe that the way our healthcare system deals with patients can be a factor to readmissions. Rather than providing someone with excellent healthcare, reversing the symptoms of their chronic disease and then sending them home to return to their poor habits, maybe they should be supported post-discharge on an out-patient basis. While it may be difficult to manage someone who doesn't know better than to continue to make their same bad choices, washing our hands of them as they leave the hospital won't help either. Maybe the answer for our healthcare system is an increase in social work or nursing case management on a community level. That way we can keep track of the problem patients, get them the out-patient community services they need to be successful, and counsel them better through the hard times in order to make sure they don't fall through the cracks until they need more acute care services. There will always be readmissions, but I hope we can do better than 19%.

      Posted by Jenn Welch, PT on 10/4/2012 12:04 AM

    • Glad to see readmissions being addressed. About 2 years ago I studied the readmission rate from one Fresno area SNF and found a 60 % readmission rate back to acute within the first week of the resident's stay. Distruptive and costly! The answer lays somewhere between behavior driven non-compliance at home and premature discharge from acute.

      Posted by Vicki Erickson, PT, Fresno, CA on 10/4/2012 9:04 AM

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