St. Joseph Medical Center was penalized under a new federal mandate challenging hospitals across the country to reduce readmission rates.
Hospital spokesman Mike Jupina attributed the fine to the fact that the hospital handles a lot of complicated heart procedures, especially among its really sick and older patients.
“When you’re dealing with heart attack and heart failure patients, you’re dealing with the sickest of the sick patients,” Jupina said. “Despite all the efforts to keep them from coming back, there are times when people do come back.”
The penalty is part of the federal Affordable Care Act and is designed to encourage hospitals to reduce patient readmissions. Without the penalty, hospitals could potentially benefit from readmissions since they could be paid by Medicare for multiple patient stays.
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The fine amounts to a 0.05 percent reduction in the hospitals’ Medicare reimbursement for 2014, according to records released earlier this month. The hospital also received a 0.06 penalty this year.
The readmission rates were determined using heart attack, heart failure and pneumonia patients between July 2009 to June 2012. It included patients who were readmitted within a month of being discharged, according to the Kaiser Health News, a nonprofit news organization that covers health care policy and politics.
Reading Hospital was not fined under the provision for its readmission rates.
St. Joseph was among 110 of the state’s 156 hospitals that received the penalty, according to the Kaiser analysis.
Its 0.05 percent penalty was considerably lower than the 0.39 percent state average.
Nationally, 2,225 out of 3,379 hospitals, or 66 percent, received fines.
Jupina said he was not sure how much the penalty would cost the hospital.
“I do not have a number because it is not a fine per se, like one would get with a traffic ticket,” Jupina said. “It is a reduced reimbursement.”
To reduce readmissions, the hospital employs navigators who help patients during their hospital stay and help coordinate follow-up appointments, fill prescriptions and provide medical records for patients’ primary care doctors soon after they are discharged, Jupina said.
He said doing complex heart procedures on complex patients will sometimes mean patients have to be readmitted.
“We do know if we want to stay on the cutting edge of heart care, patients may have to be readmitted,” Jupina said. “That’s the challenge that we face.”
Date: August 24, 2013