Wichita hospitals don’t anticipate penalties under the Affordable Care Act’s new provisions that withhold a small percentage of Medicare funds if the hospitals’ patients have to be readmitted at what the government deems excessive rates.
Estimates about which hospitals might fall under the standards come from the Centers for Medicare and Medicaid Services and the Kaiser Health Foundation.
The provision regarding reimbursements, which went into effect on Monday, applies to Medicare patients who are readmitted within 30 days of their discharge.
The penalties hospitals face depend on whether the number of patients readmitted exceeds the national average. Presently, only three conditions are being measured under the readmission provision – heart attacks, heart failure and pneumonia.
If a Medicare patient comes to the hospital for any of those three conditions and is readmitted for any condition within 30 days of being discharged, he will affect the readmission figures.
Eventually, joint replacements, stents, heart bypass and stroke will also be included.
“If we send a heart failure patient home and they get hit by a bus on day 20, we get counted for the readmission,” said JoAnn Paul, director of quality and infection control for Wesley Medical Center.
For the first year, the penalty is capped at 1 percent of a hospital’s Medicare payments. By 2015, the penalties will extend to up to 3 percent of a hospital’s total Medicare reimbursement.
Data from Wesley Medical Center show that patients who are readmitted usually come back to the hospital between one and five days after being released, or about 21 days after discharge.
Those who return within five days typically have issues with medication or have been unable to see their health care provider after being discharged, Paul said.
Those who are readmitted after a longer period generally return because they are unable to get they care they need social services or family members, Paul said.
So to reduce readmission rates, Paul said it’s important that hospitals standardize the processes used to assure that patients get the correct medications and instructions before being discharged.
The measure dealing with readmissions is being implemented at the same time some hospitals face another provision that can reduce Medicare reimbursements based on the quality of care provided, as measured by patients’ surveys and statistical data.
Via Christi Health’s Chief Medical Officer Steve Nesbit thinks the provisions will improve the quality of care for patients nationwide.
According to information available from Kaiser, two hospitals in Kansas are estimated to face substantial withholding of Medicare reimbursements under the new standards. They are Coffey County Hospital in Burlington and Morton County Hospital in Elkhart.
Government estimates show that about 2,200 facilities nationwide that serve Medicare patients will be penalized roughly $125,000 per facility this coming year, the Associated Press reports.
Contributing: Associated Press