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Hospitals face Medicare penalties for patient readmissions

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North country hospitals are increasing their efforts to reduce Medicare patient readmissions in order to avoid a reimbursement penalty from the federal insurance program.

Effective Oct. 1, hospitals faced up to a 1 percent reduction in their Medicare reimbursement payments in fiscal year 2013 if there were readmissions for pneumonia, heart attacks or heart failure within a 30-day window, according to the U.S. Centers for Medicare and Medicaid Services. Local hospital officials said that such a hit to hospitals’ revenues would damage their financial stability, especially considering several cuts to another federal insurance program — Medicaid — have plagued hospitals for the past few years.

According to the U.S. Department of Health and Human Services “Hospital Compare” data tool, all hospitals in Jefferson, Lewis and St. Lawrence counties either have no difference from the national rate for Medicare readmissions for pneumonia, heart attack and heart failure, or there were too few cases to tell. But that doesn’t mean there are no local penalties.

According to Kaiser Health News, the U.S. Centers for Medicare and Medicaid Services reported that as of Oct. 1, the following penalties would occur for fiscal year 2013 in north country hospitals:

n No penalty for E.J. Noble Hospital, Gouverneur; Samaritan Medical Center, Watertown, and Lewis County General Hospital, Lowville.

n A 0.05 percent penalty for Carthage Area Hospital.

n A 0.16 percent penalty for Canton-Potsdam Hospital, Potsdam.

n A 0.22 percent penalty for Claxton-Hepburn Medical Center, Ogdensburg.

n A 1 percent penalty for Massena Memorial Hospital.

Calls seeking comment to Claxton-Hepburn and Massena Memorial were not returned Friday.

Marlinda L. LaValley, Canton-Potsdam’s vice president for administrative services, said her hospital’s percentage equated to a $12,000 fine.

“Our readmissions were calculated just higher than the state average,” she said. “The $12,000, we’d prefer not to lose money in revenue earned, but that won’t have a measurable impact on the organization.”

Ms. LaValley said about 35 percent of Canton-Potsdam’s inpatient admissions are on Medicare.

As with other hospitals in the region, she said, Canton-Potsdam tracks its readmissions and has a data analysis staff and contracts with outside services to ensure patients get better.

Being penalized 1 percent — and even up to 3 percent within the next couple of years — of its Medicare revenue would deeply hurt E.J. Noble, Administrator Charles P. Conole said, because 43 percent of its patients use Medicare.

“It would affect us significantly,” he said. “If you take $150,000 out of E.J. Noble, that’d hurt us a great deal. We fight for every nickel here.”

Fear of penalty, according to Ben Moore III, CEO of River Hospital, Alexandria Bay, also comes with an incentive to do better. In a value-based purchasing system, he said, hospitals will be paid on outcomes, but that doesn’t apply to critical-access hospitals such as River Hospital and Clifton-Fine Hospital, Star Lake. Mr. Moore said patients who have conditions that require much care, such as pneumonia or heart issues, tend not to go to critical-access hospitals because a stay there on average is only 96 hours. If projected time in the hospital goes beyond that, patients would be transferred elsewhere, Mr. Moore said.

“It’d be an issue more for larger hospitals,” he said.

In Syracuse, the Post-Standard reported one of Central New York’s largest hospitals — St. Joseph’s Hospital Health Center — is being hit with an estimated 1 percent penalty of $875,000.

A component of the federal Affordable Care Act, penalties are something north country hospital officials said they’ve been working to avoid to ensure patients are getting the best health care possible.

“One thing is the education that we’ve attempted to do,” Mr. Conole said. “The other is good discharge planning and connecting them with good home health care.”

North country hospitals are pooling together their ideas and resources to avoid readmissions, but for Medicaid patients, it is something the Fort Drum Regional Health Planning Organization has assisted with. Executive Director Denise K. Young said an application has been sent to the Centers for Medicare and Medicaid Services to have a similar collaborative program designed to help reduce Medicare readmissions locally.

She said the process of working toward reducing Medicaid readmissions has focused on patient-centered care, as it soon will for Medicare patients.

“We’ll be working with their health provider team,” she said. “It’s patient navigators, if you will. It all goes back to bringing health care back to the primary care level.”

Barbara E. Morrow, chief compliance officer at Samaritan Medical Center, said Samaritan looks at reducing readmissions among all insurance-payers. The first step, she said, is calling patients within 72 hours of discharge and asking if they are able to receive proper at-home care and a follow-up appointment with their physician. Samaritan also is looking at developing a congestive heart failure clinic where patients could come to Samaritan for cardiac nurse visits.

The north country is not alone. According to the Associated Press, about two-thirds of the nation’s hospitals serving Medicare patients — 2,200 facilities — will have penalties averaging about $125,000 in the coming year.

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