North Carolina hospitals stand to lose hundreds of thousands of dollars as Medicare begins to hand down penalties for having high rates of patient readmissions.
The penalties against hospitals, including Cape Fear Valley Medical Center, are part of the Affordable Care Act. The idea is to get hospitals to focus more on their quality of care, instead of how many patients they treat.
Cape Fear Valley will be penalized 0.26 percent of its Medicare reimbursements starting Oct. 1. Next year, the penalty will be 0.33 percent. A hospital spokeswoman couldn’t say how much money this year’s cut means, but the 2014 penalty is about $300,000.
Southeastern Regional Medical Center in Lumberton faces a loss of $800,000 next year, or 0.92 percent.
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Neither hospital was handed down the maximum penalty of 1 percent this year, according to the Centers for Medicare and Medicaid.
This year marks the first round of penalties under the health care reform law’s Readmissions Reduction Program, which affects 2,225 hospitals at a total of about $227 million in penalties. Long-term care facilities, such as nursing homes, may fall under the penalty threat in the future.
The Medicare Payment Advisory Commission reported 12 percent of all Medicare admissions were followed by preventable readmissions in 2011. Some experts say hospital employees and physicians weren’t spending enough time with patients to coordinate post-acute care, according to the commission.
Reducing readmissions by 10 percent could equate to $1 billion in savings, according to a 2013 report.
Current penalties are based on patients who were readmitted within 30 days after being treated for heart attack, heart failure or pneumonia. The penalties will grow steeper each year and will include more patient categories, including hip or knee replacements and chronic obstructive pulmonary disease.
Readmissions can count against hospitals when a patient has to return for an unrelated condition or even an accident, whether they return to the same hospital or another one.
A statement from Cape Fear Valley said it is working on reducing readmissions for heart failure patients through its Transition of Care Clinic. The clinic provides heart failure patients with information on how to remain healthy after discharge.
“This is particularly important in a county with many uninsured residents, like Cumberland County,” the statement read. “These residents often have limited ability to get prescriptions and doctors appointments.”
Reimbursement cuts will affect 61 hospitals statewide. Non-community and military hospitals are exempt from the cuts, said Don Dalton, a spokesman for the North Carolina Hospital Association.
The Centers for Medicare and Medicaid Services usually reimburse hospitals 91 percent of the cost to treat Medicare patients, which means hospitals already were taking a loss. The new penalties on top of that will widen the loss at a time when hospitals are dealing with other revenue hits, from sequestration to the state rejecting an expansion of Medicaid coverage for the poor.
About 46 percent of patients in North Carolina hospitals fall under Medicare qualifications, Dalton said.
“When you add (the) readmission penalty to this, you are a talking about very sizable dollars. It’s likely they’ll have to look at what services they may cut or keep, and how many caregivers they can retain,” Dalton said.
Last week, Vidant Health System announced it would close a small community hospital in the coastal town of Belhaven because state lawmakers refused federal funding for the expansion of Medicaid. Gov. Pat McCrory signed the Republican-backed law in March that means about 500,000 low-income people won’t get coverage.
Date: Sep 09, 2013