Two of Savannah’s three major hospitals are being hit with Medicare payment penalties for readmissions of patients for the same diagnosis within 30 days of discharge.
They are among 73 Georgia hospitals hit with the penalties in the first two years of the program that started in October 2012, according to the Kaiser Health News.
About 68 percent of eligible hospitals in the state have received the penalty, roughly the national average. The total of readmission fines nationally is $227 million, the Health News reported.
Those hospitals treating the largest number of low-income patients are more likely to be penalized than those treating the fewest such patients, the Health News reported.
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In Savannah, Candler Hospital and Memorial University Medical Center were targeted. St. Joseph’s Hospital, Candler’s partner, avoided the penalty.
The government is concerned with readmissions of patients with the same illness within 30 days of discharge, said Paul P. Hinchey, president/CEO at St. Joseph’s/Candler. “They don’t want to pay for the second admission.”
The actions were anticipated, and the system has been preparing for them for the past three years, he said.
“It’s a very complicated issue,” Hinchey said.
It all stems from efforts by the Obama administration to cut Medicare costs for senior citizens as part of a larger cost-cutting initiative in health care.
Under guidelines for the 2013 fiscal year, only patients treated for pneumonia, heart problems or heart attack were included, Hinchey said.
For the 2014 fiscal year, diagnosis of chronic obstructive pulmonary disease, total hip replacements and total knee replacements were added.
Fully half of all patients treated by the system’s two hospitals are Medicare assisted, Hinchey said. About 20 percent of those were impacted in the first year, about 40 percent in the most recent year.
Additional conditions will be included in successive years, as well as the potential penalties.
“It’s going to become a very significant issue,” Hinchey said. “The hospital gets stuck with the bill.”
It does not mean doctors or nurses are not doing a good job, he said.
“Doctors discharge patients when they think that the patient is ready to go home,” Hinchey said. “We have no control, and we don’t get paid (by Medicare) for it.”
Candler was penalized $30,000 in fiscal year 2013 and an estimated $70,000 in fiscal year 2014, which begins Oct. 1.
In response, Hinchey said St. Joseph’s/Candler has taken steps to make sure every patient gets:
• Home health care if they need it
• Clear discharge instructions, preferably with a family member present, before leaving the hospital.
• Follow-up visits with his or her primary care physician.
• Their prescriptions filled.
The bottom line is “You don’t want that patient back. It’s not good for the patient to be back in the hospital,” Hinchey said.
At Memorial Health, parent corporation for Memorial University Medical Center, Dr. Ramon Meguiar, senior vice president and chief medical officer, said the system has been working on the issue as part of its overall quality improvement program since 2003.
He agrees with Hinchey that the Medicare action is “not a good marker of quality.”
“We can’t afford it,” he said of the Medicare repayment program. “We are carrying the burden of a population after they leave our doors. The hospitals alone cannot sustain them in a state of good health.”
Officials are seeing more severe, sicker patients who tend to use the emergency room as a primary care provider, Meguiar said.
“I see that trend continuing. That is the nature of a large health care hospital with a Level I trauma care center.” he said. “It’s a socially disadvantaged population, many with very low incomes.”
Among the system’s challenges, Meguiar said, are significant disadvantages in identifying primary care providers and patients who have had poor nutrition.
Memorial lost $10,000 during the current fiscal year out of $640,000 at risk and $144,000 for the fiscal year ending that begins Oct. 1.
“It is a multi-faceted community problem,” said Maggie Gill, Memorial president/CEO.
Gill said Memorial’s solutions include investing in:
• A patient centered medical home at the hospital’s family medicine practice for primary care physicians.
• A heart failure program to provide oversight and nursing advice after discharge.
• Assistance funds for patients once discharged.
• An emergency department program to reduce recidivism in re-admissions by helping to find care givers for follow-up care.
“We can’t bridge the gap of patient behavior,” Gill said. “We are going to have to help people ensure they get proper care.”
Date: August 13, 2013