St. Mark’s Hospital in Salt Lake City is among 17 Utah medical centers that will be punished by the federal government for having too many patients return for care after treatment.
The Centers for Medicare and Medicaid Services (CMS) released records last week identifying 2,573 hospitals nationwide that will have their Medicare payments reduced by up to 3 percent for the 2018 fiscal year that begins Oct. 1 as a result of high readmission rates, according to the nonprofit Kaiser Health News.
Readmissions following medical procedures are problematic because they can increase a patient’s risk for complications, such as infections, and significantly boost costs. Almost one in five Medicare patients are readmitted within 30 days, which costs about $15 billion a year, according to the Agency for Healthcare Research and Quality, an arm of the U.S. Department of Health and Human Services.
CMS examined the readmission rates at 32 Utah hospitals, but only 17 were penalized.
At St. Mark’s, Medicare payments will be trimmed for the second year in a row, with the highest reduction in the state: 2.81 percent, up from 1.13 percent in the current year, according to Kaiser data.
To determine penalties, federal officials examined patients between July 2013 and June 2016 who returned to hospitals within 30 days of care for six conditions, including heart attacks, pneumonia, and hip or knee replacements. Analysts then divided the number of “predicted” 30-day readmissions by the number of “expected” readmissions, the CMS website states.
But the dates CMS examined are problematic, said Marie Prothero, St. Mark’s executive vice president of quality improvement, because hospitals are being penalized based “on old data that does not take into account improvement efforts that have been underway for more than a year.”
Those improvements, Prothero said, include partnering with local skilled nursing facilities to make sure patients are following physicians orders and ensuring that follow-up appointments are scheduled and kept.
The dollar amount they will be penalized, she added, is not yet known.
CMS estimates that the penalties will equate to about $564 million in government savings, Kaiser stated.
This is the sixth year the feds have assessed Medicare penalties for hospitals under the Affordable Care Act, also referred to as Obamacare. Known as the Hospital Readmissions Reduction Program, the system was established to encourage higher quality of care.
University of Utah Hospitals and Clinics also will be penalized in the coming fiscal year, but its payments will be cut less than last year — 0.16 percent compared to 0.42 percent, according to Kaiser data.
Thomas Miller, the U.’s chief medical officer, said officials estimate their payments will be reduced between $100,00 and $200,000. The only category in which the U. struggled, Miller added, was total hip and knee replacements.
To reduce readmission rates in that category, Miller said U. officials have worked to get patients out of bed sooner than the previously recommended three days.
Fewer people are readmitted to the hospital, he added, when they are discharged to their own home instead of a nursing home.
“There‘s not a lot of physician coverage in nursing homes” so patients are sent back to the hospital for small things, such as fevers, Miller said.
The U. recently set up a phone number that patients can call from home and be quickly connected to a nurse or doctor if they experience any problems, he said. Often, the issue can be addressed over the phone, he added, and there is no need to come to the hospital.
“It‘s that ability to have a physician connect with them following discharge that allows them to recover at home more safely,” Miller said.
In a statement, U. officials also pointed to a June 2017 letter to CMS from the Association of American Medical Colleges about this and other quality rankings, saying the letter provided “perspective on this issue as it pertains to academic medical centers.”
"The nation’s teaching hospitals, which provide superior patient care and disproportionately treat disadvantaged and vulnerable patient populations, are penalized by the performance and penalty programs,” the letter states.
Other hospitals being penalized in Utah are:
- ALTA VIEW HOSPITAL
- BRIGHAM CITY COMMUNITY HOSPITAL
- CACHE VALLEY HOSPITAL
- CASTLEVIEW HOSPITAL
- DAVIS HOSPITAL AND MEDICAL CENTER
- LAKEVIEW HOSPITAL
- LOGAN REGIONAL HOSPITAL
- LONE PEAK HOSPITAL
- MOUNTAIN WEST MEDICAL CENTER
- OGDEN REGIONAL MEDICAL CENTER
- SALT LAKE REGIONAL MEDICAL CENTER
- SEVIER VALLEY MEDICAL CENTER
- TIMPANOGOS REGIONAL HOSPITAL
- UINTAH BASIN MEDICAL CENTER
- UNIVERSITY OF UTAH HOSPITALS AND CLINICS
- UTAH VALLEY HOSPITAL