Medicare penalizes N.O. hospitals for safety lapses, readmissions
18th March 2019 · 0 Comments
By Susan Buchanan
Contributing Writer
If you’re given any leeway in where to have a needed surgery, you should know that some local hospitals are considered safer than others.
The U.S. Centers for Medicare & Medicaid Services, or CMS, penalizes Medicare reimbursements to hospitals with poor safety records. That’s to spur them to improve. Under Obamacare, Medicare five years ago began dinging hospitals deemed unsafe by one percent per patient discharged. Penalties are levied under the Hospital Acquired Conditions Reduction Program for infections, blood clots, bedsores and injuries from falls.
For fiscal 2019, Medicare, which mainly serves Americans 65 and older, has penalized 800 U.S. hospitals for lax safety.
In greater New Orleans, University Medical Center and Tulane Medical Center – both downtown – have been penalized for their rates of hospital acquired conditions for five years running. Ochsner Medical Center on Jefferson Highway was dinged in fiscal 2019 and 2017. New Orleans East Hospital, which opened more than four years ago, was penalized this year. Touro Infirmary was hit with penalties in 2016 and 2017. In the five-year span, West Jefferson Medical Center was penalized just once for safety in 2018, while East Jefferson General Hospital wasn’t cited at all.
A year ago, the American Hospital Association said Medicare’s HAC reduction program needs better measures. Hospitals that are diligent in testing for infections or addressing errors may end up with poorer scores from Medicare than others, the AHA said. And the HAC program disproportionately dings large urban hospitals and teaching hospitals dealing with a complexity of patient needs, the group said.
Ochsner Medical Center, Tulane Medical Center, University Medical Center and Touro Infirmary are among the city’s teaching hospitals. UMC is also one of the state’s major safety-net hospitals, caring for low-income and other patients.
In addition to safety, Medicare penalizes hospitals up to three percent per patients discharged for readmission rates that are considered high. That’s to discourage facilities from sending patients home too soon. Ochsner Medical Center on Jefferson Highway and Ochsner Medical in Kenner, along with Tulane Medical and West Jefferson Medical, were penalized for readmissions in fiscal 2019 and each of the four previous years. UMC, East Jefferson and Touro were dinged in four of the last five years. But none of those hospitals was slapped with anywhere near Medicare’s maximum three-percent penalty for readmissions. The local facility dinged the most for readmissions in fiscal 2019 was Ochsner Medical on Jefferson Highway. It was hit with a 0.63 per patient penalty.
Medicare’s evaluations for possible penalties don’t include children’s hospitals, Veterans Health Administration hospitals and psychiatric facilities.
Hospitals serving low-income patients have complained that they shouldn’t be compared with other types of facilities for readmissions. Low-income patients, after they’re discharged, often can’t afford medicine, home-health nurses and physical therapy, and aren’t always monitored by regular doctors. In response, CMS last year assigned hospitals to peer groups of facilities with similar percents of low-income patients. Medicare compared each hospital’s readmission rate with those of its peers to decide if penalties were warranted.
Within a region, safety-net hospitals, urban teaching hospitals and rural hospitals can have disproportionate numbers of low-income patients.
Researchers have found that penalties imposed by Medicare’s Hospital Readmission Reduction Program may have pushed some doctors to avoid readmitting patients who needed hospital care. Medicare beneficiaries who were hospitalized for heart failure and pneumonia had higher 30-day, post-discharge mortality rates after the HRRP was implemented, according to a study published by Beth Israel Deaconess Medical Center, Harvard Medical School and others last year.
Last week, Medicare didn’t respond to a question about whether penalizing hospitals has had any impact on patients’ bills.
And according to Medicare, “for FY 2019, more hospitals will have an increase in their Medicare payments than will have a decrease” under its Hospital Value-Based Purchasing Program, which encourages improvements in care.
In November, The Leapfrog Group, a Washington, D.C. nonprofit, gave hospitals safety grades related to errors, injuries, accidents and infections. Ochsner Medical on Jefferson Highway, Ochsner in Kenner and Ochsner Baptist Medical Center were graded A. East Jefferson, West Jefferson and Touro earned B’s, while Tulane Medical was given a C and University Medical Center a D.
Louisiana has over 200 hospitals, with nearly half of their revenue coming from Medicare. New Orleans, Baton Rouge, Lafayette, Shreveport and Houma-Thibodaux are the state’s hospital centers.
Hospital safety has improved over the last several years in the state and across the nation, Lizheng Shi, director of Tulane University’s Health Systems Analytics Research Center, said last week. “And yet approximately a third of Louisiana’s hospitals, large and small, have been penalized by Medicare in this fiscal year,” he said. “Since its inception, targeting with penalties has generated lots of dialogue among senior hospital executives about front-line patient care and how to make improvements using Louisiana’s best practices.”
Measures to address safety include Ochsner’s Value Summits for sharing learning, Shi said. In late November, Ochsner Health Network and The Kinetix Group in New York held a second annual Value Summit in New Orleans, supported by the American Medical Group Association. Industry members discussed new ideas and best-care practices.
Those Louisiana hospitals that Medicare has penalized for a number of years require particular attention, Shi said. Efforts to improve care and sharing of learning are needed to help these stubbornly, under-performing facilities, he said.
Ochsner Medical Center in New Orleans is the state’s best hospital, according to U.S. News and World Report’s 2018-19 rankings. Ochsner is followed by Willis-Knighton Medical Center in Shreveport, Our Lady of the Lake Regional Medical Center in Baton Rouge and East Jefferson General in Metairie.
In other efforts, “The Louisiana Hospital Association’s Research and Education Foundation is working with 109 hospitals to improve patient safety through the federal Partnership for Patients Initiative,” LHA spokesman Mike Thompson said last week in Baton Rouge. The partnership aims to reduce harm to patients from a list of hospital-acquired conditions by 20 percent, versus year 2014, and to lower 30-day readmissions by 12 percent. Louisiana’s hospitals improved in six care areas in 2017-18, saving lives and cutting health-care costs by over $90 million, Thompson said.
The Louisiana Department of Health doesn’t compile patient safety reports, spokesman Robert Johannessen said last week. LDH administers the government’s Medicaid program, but not Medicare.
After its launch in 1966, Medicare began covering disabled, younger people in the 1970s. Bolstered by the Civil Rights Act, Medicare is credited with desegregating America’s hospital wards, waiting rooms and doctors’ offices. Medicare gave under-served groups access to care and spurred providers to hire African Americans. But it also contributed to the closing of many African American hospitals, including Flint-Goodridge, shut in 1983 in New Orleans.
This article originally published in the March 18, 2019 print edition of The Louisiana Weekly newspaper.
