Some North Texas hospitals will lose Medicare money starting in October. They’re being penalized because certain elderly patients were readmitted to the hospital soon after being discharged.
Until now, if a Medicare patient made a quick return to the hospital it was a money-maker for the institution. But the new healthcare law penalizes hospitals if Medicare heart and pneumonia patients are readmitted within 30 days.
Starting October 1st, hospitals could lose up to 1 percent of each Medicare claim they file. How much money is forfeited depends on the hospital’s rate of readmissions. The goal is to improve hospital care during and after the stay.
Dr. Mark Lester, Texas Health Resources clinical leader, said it’s a complex problem.
“It’s rooted in large measure on how people live and take care of themselves in the community,” Lester said. “What’s their access to care? If they do come to the hospital, how well are elements of care transitioned to where they live and work? All of those are new features for hospitals who’ve always focused on taking care of people in the community when they come to us sick, and trying to get them better so they can go out. Now, we’re really starting to look at what happens when they go out?”
Texas Health Resources will pay some of the largest penalties in North Texas. The hospital system includes Harris Methodist in Fort Worth; and Presbyterian Hospitals in Dallas, Denton and Rockwall. The fine could be about $4 million based on last year’s Medicare reimbursement figures. Federal estimates show Texas Health Resources and 2,000 other hospitals nationwide will forfeit a total of $280 million dollars in Medicare funding over the next year.
The readmission penalties for Parkland Hospital in Dallas County and John Peter Smith in Tarrant could surprise some experts who anticipated the highest readmission rates in safety-net hospitals, the ones with more low income patients. Both county hospitals' readmission counts were near zero.
Dr. Stan Pomerantz, with Parkland, said the hospital has one of the best programs in the state to track care before and after the senior citizen goes home. A key factor is a software program developed by a Parkland researcher that analyzes patient data and identifies those who are likely to be most at risk when they go home.
“We are continuing to use the software package which has been very helpful to us working directly with patients based on that information,” Pomerantz said.
Pomerantz says those patients are then targeted for additional attention before and after discharge.
“We make sure patients have their medication. They have their appointments set. They’re following their diet, that they haven’t some deterioration in their conditions. If we discover those deteriorations, we try to get them into specialty clinics as opposed to going to the emergency room,” said Pomerantz. “And that has really prevented some of those avoidable readmissions.”
Dr. Lester says Texas Health Resources is in the process of implementing that software program across its hospital system. And THR has also begun a program with nurse practitioners who make house calls, as well as phone calls, to check on recently discharged patients.
“What we’re really talking about in essence is improving care for the people in our communities,” Lester said. “And that’s what our mission is. And so, we view the expense as a vital part of what we do. And, we’re now viewing care as extending beyond out hospital walls. And so, that’s a different way of thinking than hospitals have had before.”
Hospitals have an added incentive to jump on the readmission problem: penalties triple over the next two years.