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Readmission penalties for Medicare patients hitting dozens of Georgia hospitals
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A Medicare initiative aimed at reducing readmissions of discharged patients is penalizing 88 percent of Georgia hospitals evaluated in the program.

That’s a slightly higher percentage than the national average of 83 percent of hospitals penalized in the readmission program.

The cuts in payments come as Medicare continues its campaign to encourage hospitals to reduce the number of discharged patients who return for another stay within a month.

Medicare reduced payments to 2,583 hospitals nationally, which federal officials estimate will cost a total of $563 million over a year. The penalty will be deducted from each payment for a Medicare patient stay over the fiscal year that began Oct. 1.

This year’s penalties are based on discharges from July 1, 2015 to June 30, 2018.

The average penalty will be a 0.71 percent decrease in payment for each Medicare patient who leaves the hospital over the next year, according to a Kaiser Health News analysis. 

East Georgia Regional Medical Center in Statesboro was assessed a 0.62 percent payment decrease, slightly below the state average.

The maximum penalty — a 3 percent reduction in payments — was assessed against 56 hospitals nationally.

They include what was formerly known as Chestatee Regional Hospital in Dahlonega, recently reopened under ownership by Northeast Georgia Health System.

Six other Georgia hospitals were penalized 2 percent or more, according to a KHN chart: Piedmont Columbus Regional Northside; Southeast Georgia Health System, Brunswick campus; Perry Hospital in Perry; Houston Medical Center in Warner Robins; WellStar North Fulton Hospital; and Redmond Regional in Rome.

In all, 86 hospitals in the state are being penalized.

Four Georgia hospitals that were evaluated will have no penalty: Stephens County Hospital in Toccoa; Northeast Georgia Medical Center Barrow, in Winder; Evans Memorial in Claxton; and South Georgia Medical Center, Berrien campus.

Hundreds of hospitals nationally have been exempted from the readmission program, including veterans hospitals, children’s hospitals, psychiatric hospitals or critical-access hospitals, which are the only facilities within reach of some patients.

Medicare began applying the penalties in 2012, and there has been persistent disagreement about whether they have improved patient safety, Kaiser Health News reported recently.

The penalties have encouraged hospitals to focus on how their patients recuperate, and some facilities now assist patients in obtaining medications and follow-up appointments, KHN’s Jordan Rau reported.

But the hospital industry and some academics have raised concerns that some hospitals may be avoiding readmitting patients who require additional inpatient care out of fear of the financial repercussions, while others have said the program is not showing major benefits.

“A lot of hard work has gone into trying to reduce readmissions, and the needle has not moved very far,” said Dr. Karen Joynt Maddox, co-director of the Center for Health Economics and Policy at Washington University in St. Louis, who has been skeptical of the initiative, KHN reported. “It’s been a huge investment by hospitals but not very much in outcomes, but some good things have come out of it.”

A few studies have even found an increase in mortality since the penalties took effect, but other studies, including a recent one by the Medicare Payment Advisory Commission (MedPAC), an independent body that helped devise the approach for Congress, identified no such link.

KHN reported that the MedPAC staff’s preliminary analysis found that the frequency of Medicare patients being readmitted within 30 days of discharge dropped from 16.7 percent in 2010 to 15.7 percent in 2017. But the analysis said the decrease was more significant once it took into consideration that the average patient was more frail in 2017 than in 2010 and thus more likely to end up back in the hospital, with all other things being equal.

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.

Medicare counts the readmission of patients who returned to a hospital within 30 days even if that hospital is not the one that originally treated them. In those cases, the penalty is applied to the first hospital.

The federal Centers for Medicare & Medicaid Services determines its penalties by looking at national averages for each of the conditions, so hospitals that have reduced their readmissions from previous years can still take a hit. The hospital industry argues it may be approaching the limits of how much it can do to prevent readmissions, according to Kaiser Health News. A repeat stay, hospitals say, is sometimes necessary no matter what precautions are taken.

Akin Demehin, director of policy at the American Hospital Association, told KHN: “It raises the question: Is the value of the program to improve care or just to enact penalties on hospitals?”

Ethan James of the Georgia Hospital Association said Wednesday that hospitals recognize that patient-discharge planning and post-inpatient care is crucial to helping patients heal.

“Hospitals are working with community partners to ensure that patients have access to the appropriate and necessary services to promote healing and prevent readmissions,’’ James said. “While some facilities have been penalized for readmissions, Georgia’s hospitals are making great strides in quality of care and patient safety. Patient compliance for medications and physician follow-up is greatly dependent on affordability of prescription drugs and access to transportation for post-discharge appointments.’’


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