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Medicare to penalize hospitals that readmit patients too soon

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Medicare soon will start docking payments to hospitals if they have a higher-than-expected level of patient readmissions within 30 days of being discharged. The move doesn't bode well for 10 California hospitals already identified by Medicare as having high readmission rates for patients with pneumonia or heart failure.

The federal program is making the change, which is one goal of health reform, to get a handle on a costly aspect of patient care and increase hospitals’ accountability in coordinating after-care for patients.

The program has been keeping data on instances when heart failure, heart attack and pneumonia patients return to hospitals fewer than 30 days after they were discharged.

Federal officials use a complex formula to determine whether hospitals are at, above or below the national average for readmissions. Here are the outliers identified in California, both better and worse than average, according to the latest set of Medicare Hospital Compare data:

Hospitals that don't show up on the list either don't differ from the national rate, didn't submit data or don't see enough patients to provide statistically significant information.

Medicare will reset the data collection on these measures before it starts adjusting the pay to hospitals in the "worse" categories, according to a final rule published in the Federal Register.

The move is not without controversy. Kaiser Health News reported that some hospital representatives believe they’ll be unduly penalized for activity that’s out of their control:

'A lot of this is very unfair,' says Blair Childs, a vice president at Premier, an alliance of more than 200 hospitals. He says hospitals that don't have a lot of money to invest in improving their oversight of former patients could end up losing more money under Medicare's proposals, putting them in an even bigger financial hole. In particular, he says, the changes may hurt inner city hospitals.

'These are often very stressed hospitals, and they're the ones that are going to be penalized the most,' Childs says.

Controversy aside, many health industry leaders have seen the change coming and started trying to cut down on unneeded readmissions.

The Gordon and Betty Moore Foundation provided funding to UC San Francisco Medical Center to tackle the problem, with good results so far.

Karen Rago, UCSF nurse and executive director of UCSF’s Service Line Administration, led the effort to reduce 30-day and 90-day readmission rates among elderly heart failure rates by 30 percent.

According to the foundation:

By preventing 40 patients a year from being readmitted to the hospital, the program has cut Medicare billing by at least $1 million annually, while freeing up hospital beds for other patients. More importantly, it has increased the opportunity for patients to remain at home. 

'Our patients don’t want to be in a hospital,' Rago said. 'We can keep them happier by keeping them at home.'

California Healthline also reported on the UCSF effort, which involved analysis of seniors’ diets, follow-up visits by doctors and one-on-one coaching for caregivers.

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