Earlier this week, an analysis by Kaiser Health News of hospital records found that 2,211 hospitals will be penalized this upcoming federal fiscal year under Medicare's Readmissions Reduction Program, which is part of the Patient Protection and Affordable Care Act.
The hospitals will lose a cumulative total of $280 million in Medicare funds due to their higher rates of readmission after discharge for three core diagnoses: heart attack, heart failure and pneumonia. (For FY 2013, the readmission penalties are based discharges from July 1, 2008, to June 30, 2011.) The maximum penalty for a hospital was 1 percent of base Medicare reimbursements, and 278 hospitals across the country will face the maximum.
This new information leads to more questions for the hospital industry: How will the loss of these Medicare funds affect hospitals in the short term? And what are hospitals doing to limit readmissions going forward?
Here, leaders at seven of the hospitals that will be facing the maximum 1 percent Medicare penalty next year chimed in. They say although the Medicare penalties will impact them financially next year, mass-scale initiatives to improve readmissions rates have already been under way — now it's just a matter of time, commitment and effort to ensure patients stay out of the hospital and have the proper post-discharge communication.
Dale Beatty, RN, Executive Vice President of Hospital Operations and CNO of Northwest Community Hospital (Arlington Heights, Ill.): In 2011, Northwest Community Hospital established 33 different process improvement initiatives focused on reducing readmissions. Enhancements were made in care processes, patient flow and discharge planning, organization process improvements, new care programs as well as expanding our external partnership [with other providers]. Additionally, NCH joined in the CMS Partnership for Patients via the Joint Commission Resources — the CMS initiative on reducing readmissions and preventable hospital-acquired conditions. All of these initiatives were critical components of a successful readmissions reduction plan.
As a result, NCH readmission performance is below national readmission rate averages for acute myocardial infarction, heart failure and pneumonia.
Patrick Charmel, President and CEO of Griffin Hospital (Derby, Conn.): Griffin Hospital outperformed the national average when measuring the readmission rates of patients hospitalized with pneumonia. Griffin's 30-day readmission rate for heart attack patients was 21.4 percent, slightly higher than the national average of 19.8 percent, due largely to the fact that the hospital does not offer advanced cardiac services, such as angioplasty or open heart surgery. Griffin's 30-day readmission rate for heart failure patients was 27.8 percent, 3 percentage points higher the national average of 24.8 percent. To improve that rate, we developed and launched the Valley Gateway to Health program in late 2009, a collaborative effort to better monitor and manage the region's congestive heart failure population among the hospital and area cardiologists, home healthcare agencies and skilled nursing facilities.
The initiative features better communication among the various professional caregivers, weekly telephone calls to congestive heart failure patients from hospital staff and a stronger effort to educate both patients and their family members. We're very hopeful that these types of programs and efforts are going to help us bring those readmission rates down in the very near future.
Julie Jette, Director of Media Relations at Tufts Medical Center (Boston): Tufts Medical Center is committed to reducing readmissions among all patients, including Medicare patients, and we have made significant strides in doing so. We identify patients at high risk for readmission shortly after they are initially admitted so we can focus their stay toward ensuring they won't need to return. We have enhanced patient education, especially around discharge, and many of our patients now have a follow-up appointment scheduled with their primary care provider before they leave the hospital. We have also enhanced our communications with primary care providers for patients who are facing chronic or acute illnesses that are likely to result in additional hospital stays.
We agree with CMS that reducing readmissions is an important goal for the health of patients. However, penalizing acute-care hospitals is not the way to achieve this. Medicare does not pay for home care and other supports needed to keep patients safely out of the hospital. Many of our patients who are readmitted do not have the supports they need at home, and our medical center is their safety net. To achieve sustainable long-term savings and better health outcomes, we must do more than simply assess hospitals: We need to work collaboratively to ensure we support patients across the full continuum of care.
Terry Lynam, Vice President of Public Relations at North Shore-Long Island Jewish Health System — on behalf of Forest Hills (N.Y.) Hospital and North Shore University Hospital (Manhasset, N.Y.): North Shore University Hospital incurred a penalty of $1.8 million for its readmission rate; Forest Hills Hospital's penalty was $392,000. Readmissions are something we routinely track, so we were well aware of the fact our readmission rate was higher than it should be. We have been instituting programs to reduce readmissions, including things such as outreach to patients after they are discharged and visiting patients in the home.
There is obviously recognition we are not where we should be, but we are pretty confident we'll be able to reduce that number. North Shore-LIJ Health System has taken several initiatives to reduce readmissions in our hospitals and long-term care facilities.
Benita Martin, Director of Marketing and Public Relations at Gateway Medical Center (Clarksville, Tenn.): The focus to reduce readmissions is a top priority for Gateway Medical Center and the entire healthcare industry. There are many variables outside our control after a patient is discharged, such as whether the patient goes home or to a post-acute care setting, availability of appropriate personal medical care, patient compliance with the physician's discharge instructions and other underlying health issues, particularly chronic conditions.
At admission, we identify those patients who are at the highest risk for readmission. We also regularly review readmissions to identify causative factors and opportunities to improve, such as patient education and coordination with post-discharge providers. Our hospital is committed to building on the quality of care we provide. As we continue to work with our medical staff and other healthcare resources outside of the hospital, we expect to continue to see a decline in the overall rate of patients who are readmitted.
Gateway does have more recent internal data — compared to the data that is currently available to the public — reflecting our ongoing success in reducing readmissions.
Rich Morrison, Regional Vice President of Government and Public Affairs at Florida Hospital Orlando: We will lose approximately $3 million in the upcoming federal fiscal year from our base Medicare payment.
We do not see that we will be significantly impacted by this reduction. No programs or services are in jeopardy. Florida Hospital is working on a multitude of approaches to reduce readmissions. Our efforts started more than two years ago with various projects targeted at heart attack and congestive heart failure. We are expanding our findings to the other conditions. We do not expect dramatic results next year, but we are confident that by the following year our readmission rates will have declined meaningfully.
Kenneth Sands, MD, Senior Vice President of Healthcare Quality at Beth Israel Deaconess Medical Center (Boston): Avoidable 30-day readmissions represent a costly consequence of a fragmented care system that often falls short on the promise of better health for patients following acute-care hospitalization.
We are moving ahead by being recognized as one of a very few institutions awarded a competitive grant from CMS to study readmissions, with internal programs to support transitions of care.
The hospitals will lose a cumulative total of $280 million in Medicare funds due to their higher rates of readmission after discharge for three core diagnoses: heart attack, heart failure and pneumonia. (For FY 2013, the readmission penalties are based discharges from July 1, 2008, to June 30, 2011.) The maximum penalty for a hospital was 1 percent of base Medicare reimbursements, and 278 hospitals across the country will face the maximum.
This new information leads to more questions for the hospital industry: How will the loss of these Medicare funds affect hospitals in the short term? And what are hospitals doing to limit readmissions going forward?
Here, leaders at seven of the hospitals that will be facing the maximum 1 percent Medicare penalty next year chimed in. They say although the Medicare penalties will impact them financially next year, mass-scale initiatives to improve readmissions rates have already been under way — now it's just a matter of time, commitment and effort to ensure patients stay out of the hospital and have the proper post-discharge communication.
Dale Beatty, RN, Executive Vice President of Hospital Operations and CNO of Northwest Community Hospital (Arlington Heights, Ill.): In 2011, Northwest Community Hospital established 33 different process improvement initiatives focused on reducing readmissions. Enhancements were made in care processes, patient flow and discharge planning, organization process improvements, new care programs as well as expanding our external partnership [with other providers]. Additionally, NCH joined in the CMS Partnership for Patients via the Joint Commission Resources — the CMS initiative on reducing readmissions and preventable hospital-acquired conditions. All of these initiatives were critical components of a successful readmissions reduction plan.
As a result, NCH readmission performance is below national readmission rate averages for acute myocardial infarction, heart failure and pneumonia.
Patrick Charmel, President and CEO of Griffin Hospital (Derby, Conn.): Griffin Hospital outperformed the national average when measuring the readmission rates of patients hospitalized with pneumonia. Griffin's 30-day readmission rate for heart attack patients was 21.4 percent, slightly higher than the national average of 19.8 percent, due largely to the fact that the hospital does not offer advanced cardiac services, such as angioplasty or open heart surgery. Griffin's 30-day readmission rate for heart failure patients was 27.8 percent, 3 percentage points higher the national average of 24.8 percent. To improve that rate, we developed and launched the Valley Gateway to Health program in late 2009, a collaborative effort to better monitor and manage the region's congestive heart failure population among the hospital and area cardiologists, home healthcare agencies and skilled nursing facilities.The initiative features better communication among the various professional caregivers, weekly telephone calls to congestive heart failure patients from hospital staff and a stronger effort to educate both patients and their family members. We're very hopeful that these types of programs and efforts are going to help us bring those readmission rates down in the very near future.
Julie Jette, Director of Media Relations at Tufts Medical Center (Boston): Tufts Medical Center is committed to reducing readmissions among all patients, including Medicare patients, and we have made significant strides in doing so. We identify patients at high risk for readmission shortly after they are initially admitted so we can focus their stay toward ensuring they won't need to return. We have enhanced patient education, especially around discharge, and many of our patients now have a follow-up appointment scheduled with their primary care provider before they leave the hospital. We have also enhanced our communications with primary care providers for patients who are facing chronic or acute illnesses that are likely to result in additional hospital stays.
We agree with CMS that reducing readmissions is an important goal for the health of patients. However, penalizing acute-care hospitals is not the way to achieve this. Medicare does not pay for home care and other supports needed to keep patients safely out of the hospital. Many of our patients who are readmitted do not have the supports they need at home, and our medical center is their safety net. To achieve sustainable long-term savings and better health outcomes, we must do more than simply assess hospitals: We need to work collaboratively to ensure we support patients across the full continuum of care.
Terry Lynam, Vice President of Public Relations at North Shore-Long Island Jewish Health System — on behalf of Forest Hills (N.Y.) Hospital and North Shore University Hospital (Manhasset, N.Y.): North Shore University Hospital incurred a penalty of $1.8 million for its readmission rate; Forest Hills Hospital's penalty was $392,000. Readmissions are something we routinely track, so we were well aware of the fact our readmission rate was higher than it should be. We have been instituting programs to reduce readmissions, including things such as outreach to patients after they are discharged and visiting patients in the home.
There is obviously recognition we are not where we should be, but we are pretty confident we'll be able to reduce that number. North Shore-LIJ Health System has taken several initiatives to reduce readmissions in our hospitals and long-term care facilities.Benita Martin, Director of Marketing and Public Relations at Gateway Medical Center (Clarksville, Tenn.): The focus to reduce readmissions is a top priority for Gateway Medical Center and the entire healthcare industry. There are many variables outside our control after a patient is discharged, such as whether the patient goes home or to a post-acute care setting, availability of appropriate personal medical care, patient compliance with the physician's discharge instructions and other underlying health issues, particularly chronic conditions.
At admission, we identify those patients who are at the highest risk for readmission. We also regularly review readmissions to identify causative factors and opportunities to improve, such as patient education and coordination with post-discharge providers. Our hospital is committed to building on the quality of care we provide. As we continue to work with our medical staff and other healthcare resources outside of the hospital, we expect to continue to see a decline in the overall rate of patients who are readmitted.
Gateway does have more recent internal data — compared to the data that is currently available to the public — reflecting our ongoing success in reducing readmissions.
Rich Morrison, Regional Vice President of Government and Public Affairs at Florida Hospital Orlando: We will lose approximately $3 million in the upcoming federal fiscal year from our base Medicare payment.We do not see that we will be significantly impacted by this reduction. No programs or services are in jeopardy. Florida Hospital is working on a multitude of approaches to reduce readmissions. Our efforts started more than two years ago with various projects targeted at heart attack and congestive heart failure. We are expanding our findings to the other conditions. We do not expect dramatic results next year, but we are confident that by the following year our readmission rates will have declined meaningfully.
Kenneth Sands, MD, Senior Vice President of Healthcare Quality at Beth Israel Deaconess Medical Center (Boston): Avoidable 30-day readmissions represent a costly consequence of a fragmented care system that often falls short on the promise of better health for patients following acute-care hospitalization.
We are moving ahead by being recognized as one of a very few institutions awarded a competitive grant from CMS to study readmissions, with internal programs to support transitions of care.
More Articles on the Readmissions Reduction Program:
High Readmissions Cost More Than 2k Hospitals $280M in Medicare Funds
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10 Proven Ways to Reduce Hospital Readmissions