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  • More Than 1,400 Hospitals Penalized Under Readmissions Reduction Program

    Medicare is rewarding 1,557 hospitals with bonuses and reducing payments to 1,427 others based on their readmission rates for heart attack, heart failure, and pneumonia, says a Kaiser Health News  article.

    The biggest bonus is going to Treasure Valley Hospital, a physician-owned, 10-bed hospital in Boise, Idaho, that is getting a 0.83% increase in payment for each Medicare patient. Auburn Community Hospital, a nonprofit near Syracuse, New York, is facing the biggest cut, losing 0.9% of every payment.

    On average, hospitals in Maine, Nebraska, South Dakota, Utah, and South Carolina will fare the best. Hospitals in the District of Columbia, Connecticut, New York, Wyoming, and Delaware are among the worst, the article says. 

    Results for hospitals within the same system often varied. For instance, in Rochester, Minnesota, the Mayo Clinic's Methodist Hospital will get a bonus. But Mayo's flagship St Mary's Hospital, also in Rochester, will lose money. Michael Rock, MD, an orthopedic surgeon at the Mayo Clinic, said that Medicare's scoring system tends to favor hospitals such as Methodist, which primarily does elective surgeries, over hospitals with lots of trauma and emergency cases, which St Mary's handles.

    Under the Affordable Care Act's Hospital Readmissions Reduction Program, Medicare will begin adjusting payments next month through September 2013 and will retroactively apply the changes to payments made in the last 3 months of this year.

    The bonuses and penalties do not apply to money Medicare pays hospitals for capital expenses, to teach residents, or to treat large numbers of low-income patients. Hospitals with too few cases and ones that only offer specific specialties, such as psychiatry, long-term care, rehabilitation, and cancer treatment, are exempted. Maryland hospitals also are excluded because the state has a unique reimbursement arrangement with the federal government.

    In August, Kaiser Health News reported that more than 2,000 hospitals were expected to be penalized.

    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

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