Medicare is ratcheting up its demands that hospitals do a more effective job sending patients home in better shape than when they came in.
For the past couple of years, hospitals have had their Medicare payments dinged if too many of their patients had to be readmitted in less than 30 days. Now, for the first time, hospitals also face financial penalties for excessive rates of catheter infections, as well as for avoidable injuries that patients suffer such as bedsores, blood clots and hip fractures.
The penalties are among measures in the Affordable Care Act aimed at improving health care quality, while reducing unnecessary costs. The penalties have hospitals grumbling, and some skeptics question whether these infection and injury rates really measure quality.
Ashish Jha, a respected Harvard expert on these kinds of measures, analyzed Medicare data for Kaiser Health News and found that these new penalties fell disproportionately on urban and publicly owned hospitals, often teaching hospitals, and the hospitals that tend to treat the sickest and poorest patients. This meant the Medicare program was really a “teaching-hospital penalty program,” Jha said.
Indeed, prominent on the penalty list are Truman Medical Center, St. Luke’s Hospital, Research Medical Center and the University of Kansas Hospital, the metro area’s key urban, teaching and safety-net hospitals. Public comments from some of these hospitals have echoed Jha’s observations.
Jha found a similar pattern when the readmission penalties started in October 2012: Major teaching and safety-net hospitals were more likely to face the biggest payment penalties, which now are as high as 3 percent. The available evidence suggested that their higher readmission rates were related to the kinds of patients they treated rather then to their quality of the care, Jha wrote in the Journal of the American Medical Association.
Medicare has since increased the number of conditions it monitors for readmissions, and the penalty list has grown from about two-thirds of hospitals that are subject to scrutiny to three-fourths of the hospitals this year. That includes practically every hospital in and around Kansas City.
But Truman, St. Luke’s and KU Hospital have all seen their readmission penalties steadily decline. Nationally, readmission rates are going down, as hospitals do more thorough discharge planning to keep patients healthy once they’re back at home. That’s a sign those penalties may be working as intended.
If the latest round of penalties has the same effect, we should start seeing fewer patients suffering needlessly from bedsores, infections and hip fractures.