St. John’s Medical Center is one of nine Wyoming hospitals being penalized by Medicare for the rate at which it readmits patients.
Under programs set up by the Affordable Care Act, the federal government can cut payments to hospitals with high rates of readmission. Medicare penalizes those hospitals by cutting up to 3 percent of their payment for each patient.
Data from Kaiser Health News shows St. John’s was penalized in 2015, 2016, 2018 and 2019. The percentage penalized has crept up over the years, from .81 and .82 percent in 2015 and 2016 respectively to 1.93 percent in 2018 and 2.82 percent in 2019 — the highest penalty statewide.
This year’s penalty is calculated based on data from July 2014 through June 2017. Since then, Chief Communications Officer Karen Connelly said the hospital has worked to develop processes and programs to improve readmission rates for knee and hip replacement surgery and chronic obstructive pulmonary disease.
She said the uptick could be attributed to several reasons, and the hospital is still trying to figure out how changes in 2018 to the way hospitals are grouped might have altered penalties.
“In general, being a small hospital, we aren’t too surprised when we see changes because our denominators are so small,” Connelly said. “A small number of readmissions could change our rate significantly.”
The penalty is what Kaiser calls a “signature part of the Affordable Care Act’s effort to encourage better care.”
Since 2012, Medicare has punished hospitals for having too many patients end up back in their care within a month for six targeted conditions: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, elective hip and knee replacement, and coronary artery bypass graft. In 2018, Medicare penalized almost 2,600 hospitals, amounting to an estimated $564 million in payment reductions.
The idea is that if hospitals reduce the number of returning patients, they’re taking better care of patients in the first place and in doing so, save Medicare money. Congress’ Medicare Payment Advisory Commission concluded last year that the Hospital Readmission Reduction program has saved Medicare about $2 billion a year.
The hospital industry argues that discouraging readmission may lead to increased deaths, an idea the advisory commission rejects.
Other hospitals Wyoming listed as having “excess rehospitalizations” are, in order of penalty percentage: Mountain View Regional Hospital in Casper, Cheyenne Regional Medical Center in Cheyenne, Wyoming Medical Center in Casper, Campbell County Memorial Hospital in Gillette, Evanston Regional Hospital in Evanston, Sagewest Health Care in Riverton, Memorial Hospital Sweetwater County in Rock Springs, and Ivinson Memorial Hospital in Laramie.
Data from the Centers for Medicare and Medicaid Services, or CMS, listed St. John’s rate of readmission after discharge hospital-wide as the same as the national rate of 15.3 percent. All other hospitals penalized also had no difference with the national rate hospital-wide.
When it came to the rate of readmission for patients experiencing hip and knee replacement, heart failure and chronic obstructive pulmonary disease, CMS also showed no difference between St. John’s and the national rate. The caseload is too small or nonexistent for heart attack patients. There was no data available on coronary artery bypass graft surgery patients because that procedure isn’t done locally, and a pneumonia breakdown wasn’t available.
One hospital in the state, Aspen Mountain Medical Center in Rock Springs, was penalized for hospital-acquired conditions this year.
Patients can go to khn.org/news/hospital-penalties/ to see if a hospital anywhere in the country is penalized and why.
For now, Connelly said St. John’s is focused on improving care, not merely reducing their penalty.
“We feel confident that we know what we need to do to make these improvements,” she said.