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Medicare penalties hit local hospitals
By Kalea Hall
BOARDMAN
Ed Muransky, chief executive officer of The Surgical Hospital at Southwoods, said he would still help readmitted Medicare patients even though they ultimately cost Southwoods a penalty from a federal agency.
“When [the penalty] came out, I could not believe we were in a negative category. But when you kind of dissect it, you see it is, a.) the law of small numbers, and b.) where these patients came from,” Muransky said.
“Not that it made me feel good because it is a reduction in Medicare reimbursement, but I, at least, understood how they looked at it.”
Although Southwoods is the only Mahoning Valley hospital with a 3 percent penalty in its reimbursement, it is not alone in receiving a sanction. St. Elizabeth Youngstown Hospital, St. Joseph Warren Hospital, St. Elizabeth Boardman Hospital, ValleyCare Northside Medical Center and ValleyCare Trumbull Memorial Hospital all have been penalized.
Salem Regional Medical Center is the only Mahoning Valley hospital not to receive a penalty from 2013 to 2015.
PENALTY PROGRAM
In an effort to reduce the Medicare payout every year, the Centers for Medicare and Medicaid Service, a U.S. federal agency which administers Medicare, Medicaid, the State Children’s Health Insurance Program and the Hospital Readmissions Reduction Program, launched a review program in October 2012 targeting readmission rates of patients who went to the hospital and returned within 30 days of discharge.
Five conditions have been targeted. It started with heart failure, heart attack and pneumonia. This fiscal year also included chronic lung problems, such as emphysema and bronchitis, and elective hip and knee replacements. Penalties are determined by past cases between July 1, 2010 and June 30, 2013.
The penalties are applied to patients readmitted for any condition within 30 days of discharge — not just the condition first encountered by doctors. For example, a Medicare patient who has a heart attack and goes back to any hospital within 30 days after discharge with a different ailment is considered a readmission and counts against the hospital that first admitted him.
After the evaluation of a hospital, CMS will reduce each Medicare payment by a certain percentage from October 2014 to September 2015. This is for every Medicare patient cared for by the hospital, not just those who have been readmitted.
This fiscal year, 2,638 hospitals were impacted by the penalties and total payment reduction is about $428 million, according to CMS.
In 2013, about 18 percent of Medicare patients who had been hospitalized were readmitted within a month, according to Kaiser Health News. Officials estimate that Medicare could save $17 billion from potentially avoidable readmissions.
CMS did not respond to The Vindicator’s request for comments for this story in time for publication.
SOUTHWOODS
Created in 1996, The Surgical Hospital at Southwoods is a partially physician-owned acute-care facility in Boardman that provides outpatient and inpatient surgical services in several medical specialities.
Southwoods is one of 39 hospitals in the nation to receive the 3 percent penalty.
This fiscal year, which started Oct. 1 and ends Sept. 30, 2015, is the first year Southwoods was penalized. It was also the first year CMS added the two new categories to evaluate readmissions: those with elective hip and knee replacements and those with lung aliments. And this year CMS also increased the maximum penalty from 2 percent to 3 percent.
An analysis of CMS data by Kaiser Health News shows Southwoods with 240 cases of hip/knee replacement patients. Kaiser data shows the number of readmissions is considered 11 percent above what CMS expected. The data do not show how many patients were readmitted out of the 240.
But Muransky and Steve Davenport, chief operating officer for Southwoods, said the hospital had 16 readmissions. If it had two fewer, the hospital would have been considered to be within the “expected” range determined by CMS and would not have received any reduction in its Medicare payment, Davenport said.
A closer look at the hospital’s data revealed that 94 percent of the readmitted patients were discharged to skilled nursing and acute rehabilitation facilities and 73 percent of that 95 percent were patients from the East Liverpool, Calcutta and West Virginia areas.
“A doctor begged us to take those patients up here,” Muransky said, describing how Southwoods provided the service of an orthopedic surgeon to those patients. A lot of the patients had a variety of conditions.
“I would still do it all over again,” Muransky said.
Not all patients readmitted to a hospital after being discharged from Southwoods went back to the hospital for the initial reason they were admitted. For example, some patients went back for acid reflux and asthma issues.
“Those are all things where we could have done 1,000 percent proper care, but it might not have prevented that readmission,” Davenport said.
Muransky said the next step is to contact congressmen “and discuss [our] position with them so that as the rules come out, smaller facilities might be viewed differently than the hospitals that are 20-fold of us.”
MERCY HEALTH
St. Elizabeth Youngstown Hospital’s penalties have decreased every year. In fiscal year 2013, the hospital saw a penalty of 0.85 percent, which went down to 0.74 percent in 2014 and 0.61 percent for 2015. St. Joseph Warren Hospital saw its lowest penalty thus far in fiscal year 2015 with a percentage of 0.26. The hospital started the program with a 0.28 percent penalty in 2013 that slightly increased to 0.31 percent in 2014.
Mercy Health’s St. Elizabeth Boardman Hospital is the only one of its hospitals to see an increase in penalties each year. In 2013, the hospital had a readmission penalty of 0.34 percent. That went up to 0.41 percent in 2014 and to 0.57 percent in 2015.
“We certainly focus a great deal on our patients holistically, trying to identify those who have conditions to put them at the high risk possible for a readmission,” said Don Koenig Jr., executive vice president and chief operating officer for Mercy Health Youngstown.
Koenig credits the continued decrease of penalties at Youngstown’s hospital to a team effort to follow up with the patient. Some readmissions happen because the patient doesn’t have a regular doctor or may be poor, uninsured or not have access to transportation.
Some patients, Koenig said, could benefit from home health visits.
Mercy Health also works to understand how to help patients with chronic diseases such as heart failure, lung problems or diabetes. The hospital has an outpatient congestive heart care clinic for patients to go to if they have problems after a heart attack.
At St. Elizabeth Boardman Hospital, Koenig believes growth has caused its readmissions to spike. In addition, he cites the type of patient population. The hospital admits nursing home patients who can be in a compromised state of health before they enter the hospital.
VALLEYCARE
Northside Medical Center went from a 0.50 percent penalty in 2013 to a 0.32 percent in 2014 and a 1.72 percent for 2015. Trumbull Memorial Hospital saw a penalty of 0.55 percent in 2013, to 0.38 percent in 2014 and 1.33 percent for 2015.
Trish Hrina, vice president of marketing and public relations for ValleyCare, said many variables can impact a patient’s return to a hospital after discharge including compliance with post-discharge plans.
ValleyCare hospitals are equipped with a high-risk screening tool to assist in the “evaluation and identification of specific patients who potentially could be at risk for readmissions upon arrival.”
Patients on multiple medications are referred to the clinical pharmacists for education and medication compliance and a similar program for patients with special dietary needs is in place. ValleyCare also works with post-acute care providers.
“As we continue to work with our medical staff and health care resources outside the hospital, we expect to see a decline in the overall rate of patients who are readmitted,” she said.
SALEM REGIONAL
To avoid Medicare readmission penalties, Salem Regional Medical Center has been involved in initiatives to improve the process and patient education efforts, said Michele Hoffmeister, director of public relations for the medical center.
“One of the key interventions we are using to reduce hospitalwide readmissions involves the collaborative efforts of our SRMC health care team working with other community partners to improve communication and care coordination after a patient is discharged,” Hoffmeister said.
The hospital works closely with nursing homes, skilled nursing facilities, home health agencies and others.
Salem Regional has also formed Salem Regional Medical Center’s Heart Failure program for heart failure patients to be provided education, support and follow-up calls after discharge.