Readmission Penalties Could Hinder Hospitals in Some Areas
Some health care experts in California and across the nation are concerned that smaller hospitals serving low-income communities might be the most affected by federal penalties designed to curb readmission rates for Medicare beneficiaries, KPCC's "KPCC News" reports (Schoch, "KPCC News," KPCC, 5/12).
About the Penalty
About 20% of Medicare beneficiaries are readmitted to the hospital within one month of their original visit, costing the federal government about $17 billion annually, according to federal estimates.
In October 2012, Medicare began levying financial penalties against hospitals that do not meet certain standards for readmissions. The maximum punishment is a 1% reduction in Medicare payments.
The effort to curb readmissions is central to the Affordable Care Act's goal of eliminating unnecessary care and reducing Medicare spending, which reached $556 billion in 2012 (California Healthline, 11/27/12).
California Hospitals Face Maximum Fine
Eight hospitals in California are facing the maximum 1% fine for readmissions, including:
- Centinela Hospital Medical Center in Inglewood;
- Coalinga Regional Medical Center;
- Doctors Hospital of Manteca;
- Glendale Memorial Hospital and Health Center;
- Olympia Medical Center in Los Angeles;
- Oroville Hospital;
- San Gabriel Valley Medical Center; and
- Tulare Regional Medical Center.
Most ofÂ the eight hospitals are located in low-income communities, according to Medicare data.
Details of Concerns
Tom Petersen -- executive director of the Association of California Healthcare Districts -- said that many health problems exist in rural, low-income communities that do not exist in urban regions. He added that hospitals have little control over whether their patients follow physicians' instructions and dietary restrictions after being discharged.
Nancy Foster -- vice president for quality and patient safety problems at the American Hospital Association -- said, "We think it's fair to ask hospitals to look at readmissions and see what they can do to prevent unnecessary readmissions ... [b]ut we think the current construction of the program is unfair" because it "put hospitals serving low-income patients at risk."
Support for Program
Robert Wachter -- professor and associate chair at UC-San Francisco Department of Medicine -- said that while the readmission penalty program is not perfect, it is a good start.
He said, "If you wait until the tool is less blunt, I think you'll wait forever."The article was produced with the participation of the California HealthCare Foundation Center for Health Reporting. The center is supported by a grant from CHCF, which publishes California Healthline ("KPCC News," KPCC, 5/12). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.