Area Hospitals Penalized for High Readmission Rates

More than 100 state hospitals will be penalized by Medicare for having too many patients return to a hospital within a month of being admitted for treatment. We discuss the impact these penalties will have on hospitals and patient care.

Across the nation, Medicare is fining 2,610 hospitals due to their high rates of readmitted patients.  According to Kaiser Health News, 75 percent of hospitals subject to the Hospital Readmission Reduction Program are facing penalties.

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The fines are based on readmission data from July 2010 to June 2013, or Fiscal Years 2013, 2014, and 2015. The average penalty for FY 2015 is .63 percent, up from .38 percent the previous year.

“While some penalties are as small as a hundredth of a percent, hospitals with the highest readmission rates are losing 3 percent of each payment, an increase from a maximum punishment of 2 percent last year,” according to Kaiser Health News. “The increase brings the top penalties to the full force authorized by the federal health law.”

Click on the map below to see Medicare penalties for Chicago-area hospitals in FY 2013, 2014, and 2015.

--Graphic by Travis Cornejo

Elizabeth Schulwolf is an assistant professor and director of the Division of Hospital Medicine at Loyola University Chicago. Read an interview with her.

Q: Can hospital readmissions be avoided?

That’s the billion dollar question. There are some that are unavoidable, and those avoidable readmissions are probably rare when looking at the overall pool.

I think the big question that all hospitals are trying to answer is, how can we assess which patients are at risk for readmission, and what are some of the mechanisms we can try to put in place to avoid readmission?

The problem is trying to identify those areas and knowing which patients will be at risk for readmission.

Q: Has lowering readmission rates for Medicare patients been a goal of providers?

Yes. It’s a financial impact that has helped lower readmission at both the provider and institutional level.

I think that while there is a financial penalty with this, the whole program for trying to reduce readmission has changed our focus, to see how to best transition the patient out from the hospital.

Q: Are there instances when readmissions cannot be avoided?

I think there are known complications that occur with patients, and there are unforeseen things that can happen. No matter all the efforts you can take, there are just instances that come up that you cannot avoid.

A patient could have such a severe and advanced disease or illness, that despite everything you do, they’re still going to get sick and come back to the hospital. Other factors are really hard to control, such as treating patients that are homeless, or dealing with substance abuse or psychological issues.

We try our best, but we can’t always avoid readmission.

Q: Is it fair that hospitals are penalized for readmissions?

It’s hard. The bar can be held high.

You’re assuming readmissions are avoidable, and that readmissions are due to the hospitals not doing their jobs appropriately. But there are so many other factors involved. Many readmissions are not avoidable.

It’s a challenge, and hard to put together an easy measurement generalizable to all groups. Compared to readmission, other measures are hard to capture.

Long term, I’m not sure it’s the fairest metric to use to monitor quality of care. But it’s changed how we care for our patients. We’re thinking in a more holistic manner, with less tunnel vision.

Interview has been condensed and edited.

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