Western Pennsylvania hospitals have made progress in reducing patient readmissions, according to the federal agency that oversees Medicare, although most still will be penalized in their Medicare reimbursements beginning Oct. 1.
The readmission penalty was included in the 2010 Patient Protection and Affordable Care Act. The penalty is meant to prevent hospitals from benefiting from providing poor care or inadequate discharge planning that results in readmissions. Hospitals historically have been paid for each procedure they do, so readmissions added to the bottom line, rather than hurt it.
With its second round of reviewing U.S. hospitals for higher-than-expected readmission rates within 30 days of discharge, estimates are that Medicare eventually could see a savings of $1 billion if an additional 10 percent of hospital readmissions are prevented.
Dee Mahan, a director at the patient advocacy group Families USA, says that while the penalties are aimed at getting hospitals to focus on unnecessary readmissions, "I would say a consumer, if they see their hospital on this list again, might think, 'My hospital is not changing.' Then you start to think about your other choices."
In determining the penalties, CMS looked at readmissions for three common diagnoses for Medicare patients: pneumonia, heart attack and heart failure. Because the rates are based on overlapping three-year periods, there are no major swings in readmission penalties in the second go-round.
Still, 25 of 43 Western Pennsylvania hospitals showed improved readmission rates this time and will have reduced penalties on Medicare reimbursements for the coming fiscal year beginning Oct. 1.
Another seven retained their no-penalty status from a year ago.
"I think overall it goes to demonstrate that hospitals are working on this issue," said Jane Montgomery, vice president, clinical services and quality for the Hospital Council of Western Pennsylvania.
The highest penalties were assessed to Jameson Memorial in New Castle and Allegheny Valley in Natrona Heights -- 1.07 percent and 1.01 percent, respectively -- while outlying hospitals such as Ellwood City and UPMC Bedford dominated the group receiving no penalty.
Recognizing the need to address its readmissions, Allegheny Valley, now part of Highmark's Allegheny Health Network, assembled a team in April 2012 to identify and help patients at risk of being readmitted. Patients might be considered at risk, for example, if they take several medications, or they have particularly expensive medications, or they don't have easy access to transportation.
As a result, Allegheny Valley has seen a 13 percent reduction in readmissions the past year, said Diane Frndak, vice president of safety and quality for the West Penn Allegheny Health System.
At UPMC, the region's major health system, four of its facilities had no penalty at all and the others had penalties ranging from a low of .01 percent at UPMC Presbyterian-Shadyside to a high of .53 percent at UPMC Northwest in Seneca, Venango County.
"We have implemented a number of initiatives in recent years to reduce unnecessary readmissions, but some of the key ones include having our call center reach out to patients within 48 hours after a hospital discharge to schedule a follow-up appointment with their doctor," said UPMC spokeswoman Wendy Zellner.
"We've also standardized our educational materials, making them easier to read and more appropriate for the targeted population."
The highest possible penalty is 2 percent, which will be increased to 3 percent in 2015. The Hospital & Healthsystem Association of Pennsylvania is expecting the state's hospitals to lose about $9.3 million, down from about $12 million last year, said Martin Ciccocioppo, vice president of research. He added that 71 percent of Pennsylvania hospitals face a penalty, while 29 percent of hospitals will receive none.
Hospitals in poorer or more rural areas tend to have higher readmissions as they may not have the same community-based supports to help patients once they leave the hospital.
This year, hospitals did benefit from adjustments to the CMS formula for calculating penalties by not penalizing hospitals for planned readmissions when multiple procedures are necessary. But unrelated readmissions may still be counted, such as a situation in which a patient is treated for pneumonia then returns two weeks later after being injured in a car accident.
Thoracic surgeon Robert Keenan, chief quality officer for Allegheny General and West Penn hospitals, said there also should be a distinction between "desirable" and "undesirable" readmissions.
For example, he said, at West Penn Hospital in Bloomfield, some bone marrow patients can be treated episodically instead of in one lengthy hospitalization, allowing them to spend more time at home. But each subsequent visit currently would be considered a readmission, and a mark against the hospital, even though the patient benefits.
Steve Twedt: email@example.com or 412-263-1963.