Most South Florida hospitals are improving their quality of care by one important measure under federal healthcare reform: reducing the number of Medicare patients readmitted within a month, according to recently released government data analyzed by Kaiser Health News.
But while many hospitals in Broward and Miami-Dade counties have reduced their readmission rates, Medicare identified 30 hospitals in the region that remained too high. Those hospitals will receive lowered Medicare reimbursement payments for one year beginning Oct. 1 as part of the government program’s efforts to pay healthcare providers for the quality of care they deliver and not just the number of patients they serve.
The effort seems to be working: Of the 35 area hospitals included in the federal data, a majority — 22 — received decreased penalties for 2014 compared to the prior year. Only five South Florida hospitals met Medicare’s readmission standards and will not be penalized at all, up from the three that received no penalty in 2013. And nearly a dozen — including Memorial Regional in Hollywood and Palm Springs General in Hialeah — will pay bigger fines.
The readmissions reduction program, which began in October 2012, is one of Medicare’s toughest, in part because there is no reward for improvements, and it’s not optional. Penalties for 2014 are based on readmissions of Medicare patients who originally were admitted to a hospital for a heart attack, heart failure or pneumonia and were discharged between July 2009 and June 2012.
Patients readmitted to any hospital within 30 days counted against the discharging hospital, unless the readmission had been planned when the patient originally left the hospital.
Hospitals that had more readmissions than Medicare predicted after adjusting for the severity of patients’ illnesses received a reduction in total payments.
Because Medicare applies the penalties to every payment for a patient stay, hospitals can only estimate the dollar amount of the fines.
One example: At Jackson Health System in Miami, penalties totaled about $900,000 for the year, hospital administrators said. Jackson’s penalty rate was .85 percent and dropped to .73 percent for 2014.
Healthcare experts believe the program will work to improve the overall quality of hospital care while helping to control medical costs by reducing readmissions.
The Medicare Payment Advisory Commission (MedPAC), which reports to Congress, has estimated that 12 percent of Medicare patients may be readmitted for potentially avoidable reasons. Preventing one out of every 10 of those readmissions could save Medicare $1 billion, MedPAC says.
Sal Barbera, a former hospital executive who teaches healthcare administration at Florida International University, said Medicare’s readmission reduction program has forced hospital administrators across the country to assume additional responsibilities at their own expense to ensure the well-being of their discharged patients
“It’s going to really move hospitals toward looking further than, ‘Hey, here’s a patient to discharge,’ ’’ Barbera said. “Now they’re going to have to look at the support a patient has when they go home. Who’s going to watch after them? Do they have a home? Do they need more education on medication?’’