Nearly 2,600 Hospitals Pay Medicare’s Readmission Penalties

Published August 5, 2015

The majority of the nation’s hospitals are being penalized by Medicare for having patients frequently return within a month of discharge — this time losing a combined $420 million, according to new data from the federal government.

In the fourth year of federal readmission penalties, nearly 2,600 hospitals will receive lower payments for every Medicare patient that stays in the hospital — readmitted or not — starting in October. The Hospital Readmissions Reduction Program, created by Obamacare, was designed to make hospitals pay more attention to what happens to their patients after they are discharged.

Since the fines began, national readmission rates have dropped, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month.

Some hospitals view the fines as unfair because they can lose money even if they had fewer readmissions than they did in previous years.

The San Diego Union-Tribune quotes Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, who said that despite her organization’s members spending millions on care-planning services to help prevent readmissions, there is only so much they can do.

“There are so many functions and components as to why a patient may be readmitted. A lot of them are not in the control of hospitals, and yet hospitals are the ones being penalized,” Emerson-Shea said.

The Union-Tribune quoted Scripps Health, saying these factors are the main reasons why Scripps Mercy, which often serves disadvantaged patients, has faced penalties each year of the Medicare program.

In a statement, Scripps Health said, “Access to post-hospital follow-up care has been a challenge for many of our patients, and as a result, we have created partnerships with our local network of community clinics to offer post-discharge follow-up appointments in hopes a medical home can be established,” Scripps said.

Meanwhile, criticism of Medicare’s readmission penalties appears to have support from academia.

The Union-Tribune quoted Dr. Karl Bilimoria, a researcher and assistant professor of surgical oncology at Northwestern University’s Feinberg School of Medicine in Chicago, saying that studies have shown “safety net” hospitals tend to have more readmissions. “I think there is pretty wide consensus on this issue,” he said.

Kenneth Artz ([email protected]) is managing editor of Health Care News.