Some Texas hospitals penalized by Medicare for readmissions

10/01/2012 11:34 AM

10/01/2012 11:49 AM

FORT WORTH -- Ten Tarrant County hospitals, including Medical Center of Arlington and Texas Health Harris Methodist Fort Worth, are being penalized by Medicare for the number of patients who were readmitted soon after being discharged.

The local hospitals are among 2,200 nationwide whose Medicare reimbursements are being cut by as much as 1 percent for failing to curtail readmissions. For example, if a hospital being penalized 1 percent submits a $30,000 claim, Medicare will reimburse the hospital $29,700.

The penalty is a provision of the Patient Protection and Affordable Care Act. Nationally, 1 in 5 patients returns to the hospital within a month of being discharged, costing Medicare more than $17.5 billion in additional hospital bills.

Medicare is focusing on three conditions -- heart failure, heart attack and pneumonia. They make up only a fraction of annual Medicare discharges but represent a significant number of readmissions.

The Center for Medicare and Medicaid Services will begin withholding reimbursements today. The maximum penalty rate will increase to 2 percent in October 2013 and 3 percent in October 2014.

Steve Love, president of the DFW Hospital Council, the local hospital industry's trade organization, said Medicare fails to distinguish among planned readmissions, related readmissions, unrelated readmissions and preventable readmissions.

From 2005 to 2009, Texas spent $32 billion on hospital charges for potentially preventable conditions, according to estimates by the Texas Department of State Health Services.

"I think part of this is to cut costs," Love said. "But if a patient does not follow the doctor's orders after discharge and they have to be readmitted, is that really the hospital's fault?"

Locally, the penalties hit some hospitals harder than others. Those penalized include Texas Health Presbyterian Hospital Denton at 0.74 percent, Medical Center of Arlington at 0.62 percent, Texas Health Harris Methodist Hospital Fort Worth at 0.57 percent and Baylor Regional Medical Center at Grapevine at 0.31 percent.

No Tarrant County hospital received the maximum penalty. Several, including Baylor All Saints Medical Center, Texas Health Harris Methodist HEB and USMD Hospital at Arlington, were not penalized.

The data used to assess penalties were drawn from records filed from 2008 to 2011. Texas Health Resources, an Arlington-based healthcare provider with 24 facilities in the region, began working to reduce readmission rates in 2011, spokesman Wendell Watson said.

A third of Texas Health's 12 acute-care hospitals will not be penalized this year, Watson said.

Systemwide, the provider expects to lose $2 million to $2.5 million, including $1 million in reimbursements for Texas Health Harris Methodist Hospital Fort Worth, Watson said.

"It turns out that this is an extremely complex problem," said Mark Lester, Texas Health's Southwest Zone clinical leader. "One hospital set up appointments for those patients that were discharged, and none of them kept their appointments."

Although hospitals with large low-income populations were expected to have larger penalties, John Peter Smith Hospital was penalized only 0.07 percent, which will result in a $3.64 reduction per Medicare discharge, or more than $9,300 based on 2011 figures.

Gary Floyd, JPS medical director, attributes the low rate to an extensive clinic system that places recently discharged patients with a primary healthcare provider shortly after discharge.

JPS also uses a call-back system to contact patients after discharge to ensure that they understand the doctor's instructions.

"When you buy a new cellphone you get a lot of information, and when you walk out of the store you think you have everything down," Floyd said. "Then you get home and find out you don't know how to use the thing. Walking out of a hospital is the same way."

Actually it's probably worse. Recovering patient often get out of the hospital and have to begin wading through information from healthcare providers and insurance companies as well as discharge instructions when they're trying to convalesce.

The new law will push providers toward preventive care, Floyd said.

"I would say follow-up care is critical," Floyd said. "But it's certainly not how healthcare has been set up in the past. Healthcare reform is pushing us toward better integration of inpatient and outpatient services, so more hospitals are looking at how they can bridge that gap."

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