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Medicare Docks Pay To Hospitals With Excessive Readmissions

Ruby de Luna

About one out of five Medicare patients returns to the hospital within a month after being discharged. Those readmissions are often preventable. KUOW's Ruby de Luna reports that starting in October Medicare will penalize hospitals with high readmission rates.


The new policy is part of the national health care law to reduce hospital readmissions. The goal is to reduce cost and improve patient care.

Dr. Norma Fisher Dr. Nancy Fisher is Chief Medical Officer with the Centers for Medicare and Medicaid Services, for region 10. She says three–quarters of these readmissions are preventable.

Fisher: "This is about doing things, not just for individual Medicare patient, but improve the whole system in how the hospital works."

Fisher says the policy isn't meant to discourage people from going back to the hospital when they need to. It's meant to get to the bottom of what caused their return.

For example, if someone was admitted because of a heart attack, then went home and came back later because of an infection — was the infection acquired during the first hospital stay? If that's the case, what more could the hospital do to prevent infections?

Fisher: "If the hospital identifies it and this infection was picked up and they look at it and they analyze they may put steps in to make their infection rate go down. So if the infection rates goes down, that's good because that's for the whole hospital."

Dr. Fisher says reducing preventable hospital readmissions is in everyone's interest. Patients recover faster. And it saves money in the long run.

Here's how Medicare evaluated hospitals. It looked at their readmission rates for the past three years. Specifically, it looked for heart attacks, heart failures, and pneumonia. These medical conditions were picked because they're common and costly. Medicare will cut reimbursements to hospitals with excessive readmission rates. The cuts could be as much as one percent. Next year, the maximum penalty goes up to two percent.

Hospital administrators support the goal of reducing readmissions. But some disagree with the way Medicare determines those rates. Some would argue that tracking readmissions for a month after discharge isn't a useful measure.

Haftel: "If you look at a 30–day return to the hospital for all causes, you're really not looking at what the hospital did for that patient."

Dr. Tony Haftel oversees quality for the Franciscan Health System, and that includes St. Joseph Medical Center in Tacoma. St. Joseph is one of the hospitals in Washington State that will see a reduction in its reimbursement. Haftel says some readmissions are beyond a hospital's control.

Haftel: "You're much more looking at the social and health care milieu that the patient got into, how well they took care of themselves, social issues, did they get to see their doctor. That's what a 30–day all cause kind of tells you."

Haftel says a more accurate gauge of a hospital's performance would be to look at 7 to 10 days after a patient leaves the hospital, and to see if they're being readmitted for the same medical problems.

Haftel says the Franciscan Health System had already started a couple of new projects to reduce readmissions, even before Medicare released its latest findings. One of them is a program that gives patients an automated phone call. Based on the patient's response, a nurse would follow up with another phone call.

The new Medicare penalty is an effort to get hospitals' attention and to encourage changes that improve patient care. But that's only one part of the solution. Patients have a role to play, too, says Cassie Sauer of the Washington State Hospital Association.

Sauer: "This is their part of the equation — if you understand what medications to take, on what schedule, when are you supposed to see your doctor next, what are the warning signs to be on the lookout — you're being given a treatment plan because it matters to keep you out of the hospital."

And, Sauer says, if instructions aren't followed, the chances of returning to the hospital are much higher.

I'm Ruby de Luna, KUOW News.

© Copyright 2012, KUOW

[Ed.: Transcript has been edited and differs from the broadcast version. Dr. Nancy Fisher was incorrectly referred to as Dr. Norma Fisher. (09/26/2012)]