Medicare levies higher average penalties on SoCal hospitals for high readmission rates

HHS is serious  about penalties and incentives.  Read and listen to what is happening in this space. The hospitals across the nation are getting high failure rates when attempting to meet Medicare's bar for reducing readmissions. The problem is endemic across the United States but somewhat better in the most populated state, California.

The federal government’s readmissions penalties on hospitals will reach a new high as Medicare withholds more than half a billion dollars in payments over the next year, records released Tuesday show.

The government will punish more than half of the nation’s hospitals — a total of 2,597 — having more patients than expected return within a month. While that is about the same number penalized last year, the average penalty will increase by a fifth, according to a Kaiser Health News analysis.

In California, Medicare is penalizing 225 hospitals. The average penalty is a 0.55 percent reduction in Medicare payments, less than what hospitals are facing nationwide but still a jump from last year, when the average California fine was 0.39 percent, the KHN analysis found.

In Southern California, 109 hospitals – or nearly four out of five of those reviewed in Los Angeles Orange, Riverside, San Bernardino and Ventura Counties -  got fined after the annual federal review, he says. The penalties, which take effect in October, are one of the ways the Affordable Care Act tries to get hospitals to improve patient care.  The average penalty may have increased this year because the federal government added a new measure for readmissions - heart bypass surgery.  That brings to six the number of situations Medicare uses to measure rehospitalizations. The others are heart attacks, heart failure, pneumonia, chronic lung disease and hip and knee replacements.  All of these diseases fall into the category of high expense, and chronic diseases, all of which contriibute the costs of reimbursement and health care.

The administrative burden is upon discharge coordinators, requiring significant and early pre-discharge management. If your hospital is not using an automated information technology to monitor discharges, you are facing a losing battle. Physicians must become leaders in guiding administration towards these goals.

This has  been another  report  from the  Digital Health Space:  source: California HealthLine

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