Starting in October, the federal government will penalize five area hospitals - among more than 2,000 nationally - for "excess" readmissions, in an effort to reduce Medicare costs, according to a list compiled by Kaiser Health News.
The penalties will be in the form of percentages deducted from any Medicare reimbursements Clearfield, Nason, Mount Nittany, Altoona Regional and J.C. Blair hospitals submit for the coming fiscal year.
Medicare penalized Clearfield the maximum 1 percent - a penalty 278 hospitals nationwide will share.
It penalized Nason 0.46 percent, Mount Nittany 0.28 percent and Altoona and J.C. Blair the minimum 0.01 percent.
In actual dollars, the penalties, which stem from an Affordable Health Care initiative, aren't necessarily high: Altoona, by far the largest among area hospitals, expects to pay about $9,200 for the coming fiscal year, according to spokesman Dave Cuzzolina.
Medicare based the penalties on readmissions within 30 days of discharge for heart failure, heart attack and pneumonia patients it covered between July 2008 and June 2011 - taking into account how sick patients were, but not socio-economic status, according to Kaiser.
The maximum penalty will increase by 1 percent each year over the next two fiscal years, according to Kaiser.
National researchers believe high readmission rates - especially problematic for older patients with multiple chronic illnesses - result from patients, caregivers and "downstream" providers not getting enough information; poor patient compliance with instructions; inadequate followup; variations in the availability of hospital beds; not enough reliance on family caregivers; and medical errors, according to an article published by the Congressional Research Service.
Actions taken
Clearfield has "thoroughly analyzed the findings" and initiated changes that have improved readmission rates already, according to a written response from the hospital.
The hospital has enhanced efforts to educate patients and families about medications and lifestyle modifications, partnered with long-term care facilities to ensure smooth transitions and worked with staffers and doctors on readmission guidelines, according to the statement.
Readmission of home care patients is below the state average, and an insurer recently recognized the hospital for current low readmission rates, the hospital said.
An Altoona Regional committee has been working on a variety of tactics to reduce readmissions, many requiring the hospital to "look outside the box," according to Vivian Evans, quality and research manager.
There are things hospital planners can do for patients before and after discharge that patients have traditionally done themselves - many connected with followup doctor appointments, according to Evans.
They include ensuring a patient has a family doctor, scheduling an appointment with that doctor before leaving the hospital and making sure the patient has a means of transportation to get there.
The committee has also considered the need to work with doctors about getting patients into appropriate "care settings," Evans said.
Then there are medications.
"Maybe the patient's wife lost her job," and the patient can't afford them, Evans said.
That can become the hospital's problem.
The committee has also considered the need to pay extra attention to congestive heart failure patients, because their illness tends to be cyclical, Evans said.
They often go home, feel short of breath and come right back, she said.
The efforts vary case by case.
"It's not a cookie-cutter approach," Cuzzolina said.
Altoona Regional would probably be doing this kind of work anyway, even without the penalty, Cuzzolina said.
J.C. Blair has worked on readmissions with the help of Highmark and the Hospital and Healthsystems Association of Pennsylvania's Hospital Engagement Network Project, according to spokeswoman Chris Gildea.
Workers have begun making random phone calls to patients after their discharge to ensure they understand their instructions and they've been working with family doctors and Home Nursing Agency "coaches" on follow-ups, especially for patients with chronic diseases that need to be managed intensively.
"Pretty neat initiatives," Gildea said. "[But] it doesn't come without an effort."
No foul
Two area hospitals, UMPC Bedford and Conemaugh Miners Medical Center, received no penalty from Medicare.
UPMC Bedford has kept admissions down with the help of the Highmark and HAP programs.
That work has included a study of the hospital's readmissions over the past few years, which revealed that many patients who went home believing they could take care of themselves could not, according to Al Godissart, readmission champion and case manager at UPMC Bedford.
It also showed that many patients couldn't afford their medications.
The hospital now sends detailed discharge instructions home with patients, schedules doctor's appointments up to a week before discharge and makes referrals automatically for home health services. Hospital workers also call patients at home within 72 hours of discharge to make sure home health workers are showing up, there are no issues with meds and the patient is keeping followup appointments.
The hospital also advises patients of programs at area stores that provide free or reduced-cost meds for chronic problems that often afflict the elderly, said Sherrill Wylie, vice president of quality improvement.
Hospital officials also have been advising area nursing, assisted living and personal care homes on what to do to keep their residents from coming back to the hospital unnecessarily.
As a result, personnel at those homes have brushed up on their assessment skills, Godissart said.
Home staffers also have learned to call the doctor for intravenous meds to help congestive heart failure patients who are taking on fluid or gaining excess weight rather than taking them to the emergency room.
Miners has been working on readmissions with Highmark's "Quality Blue" program for two years, while putting "policies and protocols in place" as a result of a Conemaugh system-wide readmissions initiative, according to President Bill Crowe.
As for potential concerns that hospitals would go too far the other way and not admit a patient in need, out of reluctance to run afoul of Medicare, Cuzzolina said: "I can't imagine a hospital hesitating to readmit a patient who requires it."
Reducing readmissions is an "ongoing challenge," Clearfield Hospital stated.
Mirror Staff Writer William Kibler is at 949-7038.
