Hospitals will pay up for preventable readmissions
Medical centers crow about their ranking on those "best hospital" lists. They use billboards and magazine ads to talk up their "highly rated" "top" docs, but hospitals won't be bragging about their inclusion on a new health-quality ranking from the federal government.
It lists facilities that have to pay up because they have too many "bounce backs" — patients readmitted after an inpatient stay.
The Affordable Care Act and federal regulators at the Centers for Medicare and Medicaid Services are pushing hospitals to lower the numbers of preventable readmissions. In October, hospitals will begin paying a penalty for an excessive number of Medicare patients readmitted within 30 days.
"CMS needs to remember that people are not cars," said Curt Schroder, head of the Delaware Valley Healthcare Council, the region's hospital association. "They seem to be treating hospitals like auto repair shops, in other words, 'You should be able to change the tire, send them on their way and not see them for another 5,000 miles.'"
Schroder says the federal government is using an equation that doesn't adequately account for the challenges faced by safety-net hospitals that care for many low-income and minority patients. Those patient populations have documented higher rates of readmission, he said.
Some hospitalizations can't be avoided
Hospitals across the region have formed working groups, piloted programs and generally worked hard to cut down on avoidable readmissions. But experts say some hospitalizations are simply unavoidable.
"My view is that in the current state of the American health-care system, a 30-day readmission is not a hospital metric, a 30-day readmission rate is a health system metric," said Dr. P.J. Brennan.
Brennan, the chief medical officer for the University of Pennsylvania Health System, said hospitals are trying to keep their arms around patients after discharge, but a patient's personal finances, health literacy and access to primary care are beyond the control of any individual institution.
"No patient should be readmitted within seven days. Seven days is something that every hospital ought to be able to take care of," Brennan said. "At some point, other factors begin to impact."
At Penn Medicine, executives think additional home-care services can keep some patients out of the hospital, but Brennan says many people decline the extra help.
At first Brennan thought older patients were, perhaps, hesitant to have strangers in their home.
"When we got underneath it a little further, we discovered that the patients were turning it down, primarily, because they had co-pays for every visit in the home, and they didn't want to incur expenses for those visits," Brennan said. "In a situation like that, our hands are tied, a little."
Penalties added impetus for follow through
Coy Smith is vice president for patient-care services and chief nursing officer at Wilmington's St. Francis Hospital.
"We are looking at better handoffs to home care, skilled nursing facilities, better discharge preparation of patient families and using home care as an avenue to really track them. Because it's the right thing to do, truly," Smith said. "But having these penalties over our head does kind of make a difference."
The new penalties are based on data for three health conditions: heart attack, heart failure and pneumonia. Smith said St. Francis has lowered readmission rates for all three categories in the last 18 months, but the new ranking use historical three-year data from 2008 to early 2011.
The maximum readmission penalty is 1 percent of a hospital's Medicare reimbursement.
St. Francis is facing a 0.66 percent penalty. Temple University gets dinged with 0.49 percent less money. Thomas Jefferson University's fine is 0.57 percent. Cooper University Hospital in Camden will lose 0.96 percent.
"These regulations present some challenges that are concerning," said a statement from Cooper Hospital. "The penalty applies to "all-cause" readmissions within 30 days – so if the patient develops a problem unrelated to the reason for the initial admission that requires hospital care, the penalty may still apply. It also includes readmissions to other facilities, meaning that if the patient presents to another ER or hospital for care, the penalty applies, even if the original facility/physician isn't notified or even aware, and so may not have the opportunity to intervene to prevent that readmission."
Philadelphia's three Penn Medicine hospitals, which are within walking distance of one another, face wide-ranging fines: The Hospital of the University of Pennsylvania -- 0.02 percent; Penn Presbyterian Medical Center — 0.06 percent; Pennsylvania Hospital — the full 1 percent.
"It shows that it's a lot more than geography," Brennan said.
What does it signify for patients?
Kerry McKean Kelly, spokeswoman for the New Jersey Hospital Association, said it's not clear yet if publishing the readmission penalties will be helpful for patients.
"So what we always recommend to consumers is that you just take, not just a single source of health-care data but get as much information as possible to get a full picture of the quality of health care," Kelly said.
Brennan said hospitals agree they need to shift the way they do business and take wider responsibility for patients once they leave, but the question is "how much responsibly?"
Hospital executives and other care-quality hawks continue to debate what readmissions are avoidable and which are not.
The federal government is upping the ante soon. In 2013 the maximum readmission penalty increase to 2 percent of each center's Medicare reimbursements.
Taunya English's story is part of a project on health in the states a partnership of WHYY, NPR and Kaiser Health News.