Spare the rod and spoil the child.


Medicare fined 2,610 hospitals, a record, for too many re-admissions.


Interestingly, the national rate for readmissions is getting lower. Still, last year, 18% of Medicare patients were re-admitted within a month. Medicare believes these re-admissions costs them $26 billion; and that $17 billion comes from potentially avoidable readmissions.


Under the new fines, ¾ of hospitals subject to the Hospital Readmission Reduction Program are being penalized. Over the next year, these hospitals will receive lower payments for ALL Medicare payments they received – not just for those patients they readmitted. The total – $428 million. A drop in the bucket compared to all Medicare payments.


Now, many hospitals are exempted from the Program – actually over 1,400 facilities. These include certain cancer hospitals, critical access hospitals, psychiatry and rehab facilities. Maryland hospitals are also exempt as they have a separate payment program with Medicare.


In New Jersey, almost every hospital will be penalized. So will a majority of hospitals in 28 other states.


Some penalties are just a slap on the wrist. Others are a serious chunk of change. Those with the highest readmission rates will see a haircut of 3% for each Medicare payment. You might say – 3%; that’s chump change. But, for some facilities that depend upon Medicare for its survival, that difference might be another nail in a coffin.


Medicare levied penalties against 433 MORE hospitals this year compared to last. Why? There are more categories being measured. Two new categories include elective hip/knee replacements; and lung ailments such as chronic bronchitis. This adds to the list that already included congestive heart failure, myocardial infarct, and pneumonia. A hospital was fined if it had higher than expected readmission rates in ANY category. Thus, a number of specialty hospitals that focus on hip and knee replacements received fines for the first time because readmissions of those patients are now being assessed.


Some hospitals have hired consultants to help prevent re-admissions.


Gina Kaurich, director of client-care services at the Cincinnati-based FirstLight HomeCare, one such consultant, said:


Some have tried to care for returning patients without readmitting them overnight so Medicare does not count their cases, she said. Others have assigned their own nurses to visit patients at home shortly after discharge to ensure the patients are properly taking care of themselves. Still others hire private companies like hers, which sends nurse assistants to homes.


It’s a noble goal to cut down on preventable re-admissions. But, that competes with the goal of getting the patient out of the door ASAP to keep costs down – or because the patient does not want to be exposed any longer than necessary to antibiotic-resistant bugs. With so many hospitals getting dinged, you have to wonder if this readmission prevention program was designed properly.


What do you think?