55 Indiana hospitals facing fines for excessive readmissions

Fifty-five Indiana hospitals will get docked more than $8 million in total from the federal government for having too many Medicare patients return for care within a month of discharge.

The number is down from 62 hospitals last year and 66 the before, but will still cost many hospitals money while they are still dealing with the strain of the pandemic that has overwhelmed resources and reduced their revenue and profits.

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

The Centers for Medicare & Medicaid Services said Monday that it was penalizing 2,273 hospitals across the nation. That’s the fewest since the fiscal year that ended in September 2014, according to an analysis by Kaiser Health News.

The Indiana Hospital Association said it expects the total amount of penalties assessed to be $8.14 million, a decrease of 1.3% from last year.

“Indiana hospitals are committed to quality and have worked diligently to improve discharge planning processes, care coordination, patient education, and social determinants of health in their communities,” the hospital association told IBJ in an email. “We are proud to report that 74% of Indiana hospitals remained the same or improved over the last year. In addition, Indiana outperformed neighboring states Michigan, Illinois, and Kentucky in reducing readmission rates.”

For those hospitals incurring a penalty, the range of penalties is from $0 to $970,600, with the average being $150,756, the association said.

“Hospital readmission reporting is only one of numerous federal quality measures and Indiana performs highly when you look across the patient safety continuum,” the association said. “In fact, Indiana is ranked 10th in the nation when looking at a composite of patient safety indicators and is best in comparison to Illinois, Kentucky, Michigan, and Ohio.”

The figures do not include Indiana hospitals that Medicare exempted from the program, 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. In Indiana, 65 hospitals were exempt for this reason.

The maximum penalty is a 3% reduction in payments in Medicare payments. The highest penalty against an Indiana hospital was 2.71% reduction in payments for St. Mary Medical Center in Hobart, owned by Community Healthcare System, based in Munster.

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.

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.

Fifteen hospitals in Indiana received no penalty this year, including Eskenazi Health in Indianapolis, Hendricks Regional Health in Danville, Ascension St. Vincent hospitals in Carmel and Fishers, Ortho Indy Hospital in Indianapolis, Franciscan Health hospitals in Crawfordsville, Lafayette and Mooresville, and Indiana University Health in Bloomington.

In central Indiana, 13 hospitals will see penalties:

Hancock Regional Hospital (Greenfield): 1.55%

Riverview Health (Noblesville): 1.31%

Community Health East (Indianapolis): 1.13%

Indiana University Health North (Carmel): 0.75%

Community Health South (Indianapolis): 0.6%

Indiana University Health West (Avon): 0.57%

Franciscan Health (Indianapolis): 0.4%

Major Hospital (Shelbyville): 0.39%

Indiana University Health Methodist/University (Indianapolis): 0.37%

Witham Health (Lebanon) 0.36%

Ascension St. Vincent (Indianapolis): 0.12%

Community Health North (Indianapolis): 0.1%

Johnson Memorial Hospital (Franklin): 0.03%