Hospital improvements won't avoid Medicare penalties

Tools

Despite improved scores, some hospitals still face big Medicare penalties for readmission rates. North Carolina's Wake Forest Baptist, for instance, saw better ratings in two of six main categories of care, yet Medicare is docking the hospital's reimbursement by 0.82 percent, the Winston-Salem Journal reported.

Many hospitals like Wake Forest Baptist partner with other provider organizations to improve transitional care and lower readmission rates, only to be discouraged by outdated Medicare data that disregards ongoing improvements and progress, the article noted.

"I'm not sure it is possible to put more focus into our efforts on readmissions," Wake Forest Baptist Medical Center Chief Medical Officer Russell Howerton told the newspaper.

Academic medical centers, in particular, face an uphill battle, getting hit with Medicare penalties for what they say are "uncontrollable" patient outcomes related to medication nonahderence or inadequate transportation, according to The New York Times.

In fact, a Journal of General Internal Medicine study last month found that many readmissions stem from social factors outside of hospitals' control--such as patients' income level, employment status, race, education and age.

But according to Barnes-Jewish Hospital, efforts to address social factors might not be enough to avoid Medicare reimbursement penalties. Even though the St. Louis hospital scheduled follow-up appointments for patients without a primary care doctor, sent reminder phone calls and organized free rides, almost half of the patients never showed, the NYT noted.

"Many of us have been working on this for other reasons than a penalty for many years, and we've found it's very hard to move," said John Lynch, chief medical officer at Barnes-Jewish, which stands to lose $2 million in penalties this year. "For us, it's not a readmissions penalty. It's a mission penalty," he told the NYT.

For more:
- read the Winston-Salem Journal article
- here's the NYT article

Related Articles:
CFOs may work readmission penalties into bottom line
Readmission programs could violate anti-fraud laws
Can hospitals control social factors in readmissions?
Readmission calculations unfair to hospitals
Are there any winners under the readmission reduction program?