By Marcus Rauhut
mrauhut@publicopinionnews.com @MarcusRauhutPO on Twitter
CHAMBERSBURG >> Chambersburg and Waynesboro hospitals are among the record number of hospitals nationwide facing Medicare penalties for patient readmission rates.
More than 2,600 hospitals will see reduced Medicare payments under the third year of the federal Hospital Readmissions Reduction Program.
Despite declining readmission rates, both Chambersburg and Waynesboro hospitals will see Medicare payments trimmed by less than half a percent.
“Rates at both hospitals are declining,” said Dr. Tom Anderson, chief medical officer and vice president of medical affairs . “Our rates generally are good, but like most hospitals, we have room for improvement.”
Chambersburg Hospital was not penalized the last two years. This is the third year that Waynesboro Hospital received a reimbursement reduction, according to data from Kaiser Health News.
“We are working on improving the coordination of care for patients discharged from the hospitals. Also, we are taking steps to ensure that patients have appropriate follow up care, access to their medications, and other on-going care,” Anderson said.
Medicare represents the largest payer for Summit Health. Currently, about 50 percent of revenue comes from Medicare, Anderson said.
In assessing hospitals, the Centers for Medicare & Medicaid Services looks at the number of patients with five conditions who are readmitted to the hospital within 30 days. Assessments are based on data from July 1, 2010, and June 30, 2013.
The Hospital & Healthsystem Association of Pennsylvania expects hospitals statewide to lose a little more than $21 million in the new federal fiscal year, which began Oct. 1.
That’s more than double the amount last year, when Pennsylvania hospitals lost more than $9 million in Medicare payments due to the readmission payment penalty.
HAP cited three reasons for the difference:
• The time period being studied and the benchmark shifted ahead one year;
• In 2015, the initial three conditions — heart failure, heart attack, and pneumonia care — were expanded to include COPD and hip and knee replacements;
• Also in 2015, the maximum penalty increased from 2 percent to 3 percent;
“Even though readmissions are going down and hospitals are doing a better job of managing the care of the patient while they’re a patient and after they’re discharged, because the average is recalibrated every year, you’re always going to have roughly half the hospitals above average no matter what,” said Martin Ciccocioppo, HAP vice president, research.
Despite falling readmission rates nationwide, a record number of hospitals were penalized in the third year of the Hospital Readmissions Reduction Program, one of three pay-for-performance programs under the Affordable Care Act.
Ciccocioppo said hospitals are still waiting to see the final impact of the other two programs.
The Value-Based Purchasing Program is based on measures of timely and effective care, patient surveys and mortality rates. The Hospital-Acquired Condition Reduction Program penalizes hospitals with the highest rates of hospital-acquired infections, blood clots, bed sores or other conditions.
Medicare is the single largest payer for acute care hospitals. Even in small percentages, reimbursement reductions can have a big impact on hospitals.
“Essentially, hospitals get paid by Medicare about 95 cents per each dollar expense they incur treating Medicare patients. You’ve got the largest payer already not paying 100 percent of costs,” Ciccocioppo said. “And if you’re ratcheting down the reimbursement stream under these pay-for-performance programs, it’s big dollars.”