Obamacare penalties clobber NC hospitals and patients, Economically depressed areas hit hardest, Readmissions within 30 days for any reason trigger fine

“If you like your health care plan, you can keep your health care plan.”…Barack Obama

“About two-thirds of the hospitals serving Medicare patients, or some 2,200 facilities, will be hit with penalties averaging around $125,000 per facility this coming year, according to government estimates.”…NE News Now

“The Patient Protection and Affordable Care Act (PPACA)[1] imposes numerous tax hikes that transfer more than $500 billion over 10 years—and more in the future—from hardworking American families and businesses to Congress for spending on new entitlements and subsidies. In addition, higher tax rates on working and investing will discourage economic growth both now and in the future, further lowering the standard of living.”…Heritage Foundation

Admittedly, hospitals and the medical profession need to be more efficient and strive for patient friendly cost savings. However, arbitrary blanket decisions by government bureaucrats are not the solution.

From the Raleigh News Observer November 24, 2012.

“Hospitals scramble to limit readmissions, avoid new penalties”

“The patient – decked out in non-skid footies, a loose hospital gown and a breathing tube – prays she’s finally on the mend. At age 81, Juanita King had logged nearly five weeks at WakeMed Hospital since October after her breathing became so labored she had trouble walking.

The Clayton grandmother, weakened by a failing heart and obstructed lungs, wasn’t home even two weeks after the first hospital stay before returning to WakeMed earlier this month for another round of needles, meds and tests.

WakeMed, along with hospitals across the country, is scrambling to keep patients like King from coming back. Under federal penalties that kicked in Oct. 1 as part of the Patient Protection and Affordable Care Act, hospitals lose Medicare reimbursements if their patients are readmitted at an excessive rate.

WakeMed officials, for example, estimate that the 15 readmissions since 2010 that Medicare deemed excessive will cost the Raleigh health care company more than $400,000 in the coming year.

To ease the financial sting, hospitals increasingly are trying to manage patients’ health care after they are discharged. Hospital personnel make follow-up calls, schedule doctors’ visits and set up therapy appointments. Duke University Health System is planning to offer apps designed to send prompts and reminders for patients to take meds and report symptoms.

Hospital administrators say the pressure to reduce readmissions is forcing them to take steps that are long overdue – by coordinating with nursing homes and family caretakers to treat health problems early, before they blow up into emergencies.”

“But industry advocates warn of a potential downside: Struggling hospitals, spooked by the prospect of huge penalties, could develop an unhealthy fixation on finding ways not to readmit patients who need hospital care.

Already hospitals nationwide have seen an uptick in patients being steered to observation beds rather than getting admitted, Foster said. Hospitals in economically distressed areas with limited health care options are most likely to readmit patients and pay penalties for doing so, she said.

“It’s hard to think there will be a financial penalty against your organization to do the right thing by your patient.” Foster said. “We don’t think that hospitals that serve impoverished, safety-net communities should be penalized because those communities lack the necessary resources.”

Readmissions are only one of several factors the federal government is tracking to reduce the cost of health care. All told, within several years hospitals could face up to an 8 percent reduction in Medicare reimbursements – for failing to meet new federal standards for electronic medical records and for too many infections and errors, among other quality measures, according to the American Hospital Association.

Insurance companies are likely to adopt similar measures, based on the model developed by Medicare, the nation’s federal insurance program for the elderly. Blue Cross Blue Shield of North Carolina, the state’s largest private insurer, now offers financial rewards for hospitals that reduce readmissions. But unlike Medicare, Blue Cross doesn’t penalize hospitals for too many readmissions, said spokesman Lew Borman.

The maximum Medicare penalty this year for excessive readmissions is a 1 percent reduction in Medicare reimbursements. The fine will increase to 3 percent in 2015, which can translate to millions of dollars in lost revenue for a hospital.

The fines apply for readmitting too many patients with at least one of three conditions – heart failure, heart attack or pneumonia – within 30 days of discharge. Medicare is expected to add more diagnoses in the coming years, expanding the range of potential penalties.

A readmission can be for any cause – usually not the fault of the hospital. A pneumonia patient who leaves WakeMed, has a car wreck on the way home and is readmitted to Rex Hospital? Under Medicare, that counts as a readmission against WakeMed.

Each hospital is allotted a certain number of readmissions, based on a complex formula that factors in fluke scenarios like auto accidents, slips-and-falls and others unrelated to heart conditions or pneumonia.

Patients often go back into a hospital because they have trouble following directions for their medications. During a hospital stay and while recuperating, patients can be disoriented and confused, making it hard to keep track of multiple medications.

Heart patients, for example, are urged to adhere to a low sodium diet, but not all comply. “We had one patient who was taking their pills with pickle juice,” said Linda Butler, chief medical officer at Rex Healthcare in Raleigh.

In North Carolina, a half-dozen hospitals were levied either the maximum Medicare penalty for excessive readmissions or a penalty very close to the 1 percent max. The hospitals are in Ahoskie, Lumberton, Eden, Williamston, Hamlet and Rocky Mount, according to an analysis by Kaiser Health News. Hospital officials note that areas where hospitals get hit with high penalties are typically in economically depressed areas with limited access to therapists, specialists and other resources essential for preventing hospital readmissions.”