Nine hospitals in Kentucky get maximum Medicare penalty for readmissions; they blame socioeconomic factors

Article updated 10/20/2014
Nine hospitals in Kentucky, eight of them in Appalachia, have been hit with the highest penalty possible by Medicare for high rates of patient readmission.

This is the third year the program has fined hospitals, under the federal health-reform law, for having too many patients return within 30 days for additional treatment.

This year, the maximum penalty is a 3 percent reduction in Medicare payments for all patient stays in the fiscal year beginning Oct. 1. Last year, the cut was 2 percent. The fines are based on readmissions from July 2010 through June 2013.

Kentucky hospitals fined the maximum amount this year are the Appalachian Regional Healthcare hospitals in Harlan, Whitesburg and Hazard; Memorial Hospital in Manchester; Methodist Hospital in Henderson; Pineville Community Hospital in Bell County; Three Rivers Medical Center in Louisa; Monroe County Medical Center in Tompkinsville; and Westlake Regional Hospital in Columbia. All except Henderson are in Appalachia, and most are in Eastern Kentucky.

“Some of the specific challenges that have faced hospitals in Eastern Kentucky is that they see a greater proportion of patients who have suffered from heart attacks, heart failure and pneumonia,” Elizabeth Cobb, vice president for health policy at the Kentucky Health Association, told Kevin Halpern of the Middlesboro Daily News.

Cobb also said the region has “higher numbers of chronically ill patients, who require a greater amount of hospitalization,” and that high rates of obesity and smoking, which affect how well a patient does after discharge, as well as a lack of oupatient services in rural areas, also contribute to readmissions. The formula for calculating readmission penalties does not take such problems into account.

Nationwide, 2,610 hospitals received a readmissions penalty, but only 39 were hit with the full 3 percent. In Kentucky, 63 hospitals, about two-thirds of the state’s total, were penalized, with the average penalty being a 1.21 percent reduction in payment, according to an analysis of federal records from Kaiser Health News.

Halpern, citing KHA, reported that Kentucky represented a “disproportionate share of (the) hospitals receiving the maximum penalty, with nine hospitals, representing 23 percent of the total.”

KHA supports pending legislation that will require the Centers for Medicare and Medicaid Services to adjust its program to account for socioeconomic conditions that “are beyond a hospital’s control,” Halpern reports. Opponents say “hospitals that have many readmissions are providing substandard care and should not be let off the hook,” Kaiser’s Jordan Rau reports.

The penalties have forced hospitals to provide better follow-up care for their patients after discharge in efforts to avoid readmission. The days of handing a patient a written discharge plan and expecting the patient to follow them without follow-up are quickly becoming a thing of the past, Rau reports.

Instead, hospitals are finding ways to ensure patients are not readmitted like ensuring outside doctors monitor discharged patient’s recoveries; providing free medication for those who can’t afford them; or sending a nurse to a patients home to make sure they are taking care of themselves.

But some hospitals are still struggling with these new guidelines, resisting many such efforts because they aren’t paid for these services, Rau reports, and some continue to readmit patients because it has been financially beneficial to the hospital in the past.

Medicare officials estimate that $17 billion of the $26 billion Medicare pays for readmissions is a result of “potentially avoidable readmissions,” Rau reports.

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