60 Indiana hospitals penalized for high number of readmissions

Sixty Indiana hospitals are being fined a total of $10.2 million for having too many patients return for care within a month of discharge.

The federal government says readmissions are often unnecessary and cost taxpayers tens of billions of dollars a year for treatments that should have been caught the first time around, or were not followed up adequately.

So, for the eighth consecutive year, it is using the pressure of lower reimbursements to get hospitals to improve their numbers.

The penalties against Indiana hospitals dropped from 66 last year.  The Indiana Hospital Association said in a statement that its members “are committed to providing excellent patient care and are working diligently to reduce preventable readmissions.”

The Centers for Medicare & Medicaid Services said that 2,583 hospitals across the United States would be docked as a result of having too many patients readmitted within 30 days of discharge.

These figures do not include 2,142 hospitals that Medicare exempted from the program this year, either because they had too few cases to judge; were veterans hospitals, children’s hospitals, psychiatric hospitals; or were critical-access hospitals, which are the only hospitals within reach of some patients.

The maximum penalty–a 3% reduction in payments—was assessed against 56 hospitals, including one in Indiana, Kentuckiana Medical Center in Clarksville.

In central Indiana, 17 hospitals will see penalties:

• Community Hospital North, Indianapolis (1.56%)
• Community Hospital East, Indianapolis (0.92%)
• Witham Health, Lebanon (0.79%)
• OrthoIndy Hospital, Indianapolis (0.73%)
• Community Hospital South, Indianapolis (0.54%)
• Indiana University Health West, Avon, (0.45%)
• Major Hospital, Shelbyville (0.42%)
• Indiana University Health, Indianapolis (0.28%)
• St. Vincent Hospital, Fishers (0.27%)
• St. Vincent Hospital, Carmel (0.26%)
• Hancock Regional Hospital, Greenfield (0.21%)
• Franciscan Health, Indianapolis (0.17%)
• Johnson Memorial Hospital, Franklin (0.14%)
• Hendricks Regional Health, Danville (0.12%)
• Indiana University Health, Carmel (0.06%)
• Riverview Health, Noblesville (0.02%)
• St. Vincent Hospital, Indianapolis (0.01%)

Many hospitals say they take pains to monitor patients and help them recover in an effort to avoid preventable readmissions. They send patients home with thick, detailed packets of discharge instructions and a month’s worth of medications. Hospitals send nurses and aides to patients’ homes to see how they are doing. In some cases, patients are given vouchers for cabs or van shuttles to get to their primary care physicians for follow-up visits.

Indianapolis-based Community Health Network, which saw three of its hospitals ranked among the top five in the region for penalties, said it has seen “significant decreases” in readmissions rates and is continuing to look for more ways to improve.

“We employ and deploy health advocates to the homes of patients to make sure they receive proper care. We offer free meal vouchers to our senior populations,” Dr. Robin Ledyard, Community Health Network chief medical officer, said in a written statement. “Through the work of our foundation, we provide transportation to medical appointments for cancer patients. Our goal and expectation is to continue to see improvements not only in our readmission rates, but other quality outcomes.”

Likewise, Franciscan Health said it uses a comprehensive “accountable care” program to coordinate care for its patients, and uses nurses and social workers to help patients after discharge to keep them healthy and avoid additional hospitalizations.

“Despite these effective programs, patients are still occasionally readmitted for their significant health issues,” Franciscan said in a statement.

The penalties are based on the frequency of readmissions of Medicare patients who had originally been treated for heart failure, heart attack, pneumonia, chronic lung disease, hip and knee replacement or coronary artery bypass graft surgery. Readmissions that were scheduled to occur are not counted.

Medicare estimates the penalties will cost hospitals $563 million over a year. Of the 3,129 general hospitals evaluated in the Hospital Readmission Reduction Program, 83% received a penalty, which will be deducted from each payment for a Medicare patient stay over the fiscal year that began Oct. 1, according to Kaiser Health News.

Although Medicare began applying the penalties in 2012, disagreements continue about whether they have improved patient safety. On the positive side, they have encouraged hospitals to focus on how their patients recuperate, and some now assist them in procuring medications and follow-up appointments.

But the hospital industry and some academics have raised concerns that some hospitals may be avoiding readmitting patients who require additional inpatient care out of fear of the financial repercussions, while others have said the program is not showing major benefits.

Medicare counts the readmission of patients who returned to a hospital within 30 days even if that hospital is not the one that originally treated them. In those cases, the penalty is applied to the first hospital. This year’s penalties are based on discharges from July 1, 2015, to June 30, 2018.

The average penalty will be a 0.71% decrease in payment for each Medicare patient who leaves the hospital over the next year.

(Kaiser Health News contributed to this report.)