Via KELO Radio, we learn that Medicare is reducing payments to nine South Dakota hospitals as punishment for seeing too many patients come back for seconds—i.e., for not curing what ailed us the first time. Medicare is lowering payments another 1% to three of those hospitals—Brookings Health System, Monument Health in Rapid, and Sanford in Aberdeen—for excessive infection rates—i.e., making patients sick with something else while they visit.
- Avera McKennan, Sioux Falls: 0.19% decrease in reimbursements for high readmissions.
- Avera St. Luke’s, Aberdeen: 0.05% decrease in reimbursement for high readmissions.
- Avera St. Mary’s, Pierre: 0.97% decrease in reimbursement for high readmissions.
- Brookings Health System: 0.22% decrease in reimbursement for high readmissions. 1% decrease for hospital-acquired conditions.
- Dunes Surgical Hospital, Dakota Dunes: 2.3% decrease in reimbursement for high readmissions.
- Monument Health, Rapid City: 0.16% decrease in reimbursement for high readmissions. 1% decrease for hospital-acquired conditions.
- Monument Health, Spearfish: 0.86% decrease in reimbursement for high readmissions.
- Prairie Lakes Health, Watertown: 0.13 decrease in reimbursement for high readmissions.
- Sanford Health, Aberdeen: 0.44% decrease in reimbursement for high readmissions. 1% decrease for hospital-acquired conditions [Todd Epp, “Feds to Ding Nine S.D. Hospitals’ Medicare Payments for High Readmissions, Infections,” KELO Radio, 2021.10.28].
None of South Dakota’s hospitals incurred the maximum readmission penalty of 3%, which was leveled on 39 hospitals across the U.S.
According to Kaiser Health News, Medicare is reducing payments to 2,499 hospitals nationwide. That’s 47% of all hospitals, but Medicare exempts 2,216 facilities from these penalties “because they specialize in children, psychiatric patients, or veterans.” So of the 3,046 hospital subject to review of readmission rates, 82% are getting some penalty. These penalties are based on Medicare patient discharges from July 1, 2017, to December 1, 2019, so they do not include any hospitalizations during the coronavirus pandemic.
Kaiser Health News describes this Hospital Readmissions Reduction Program, started in 2012 as part of the Affordable Care Act, as “an effort to make hospitals pay more attention to patients after they leave.” Data from Congress’s Medicare Payment Advisory Commission indicates that, in addition to saving Uncle Sam $521 million in Fiscal Year 2022, the penalties are driving readmission rates down:
MedPAC [has found readmission rates declined from 2008 to 2017 after the overall health conditions of patients were taken into account. Heart failure patient readmission rates dropped from 24.8% to 20.5%, heart attack patient rates dropped from 19.7% to 15.5%, and pneumonia patient rates decreased from 20% to 15.8%, according to the most recent MedPAC analysis. Readmission rates for chronic obstructive pulmonary disease, hip and knee replacements, and conditions that are not tracked and penalized in the penalty program also decreased.
“The HRRP has been successful in reducing readmissions, without causing an adverse effect on beneficiary mortality,” MedPAC wrote. The commission added that untangling the exact causes of the readmission rates was complicated by changes in how hospitals recorded patient characteristics in billing Medicare and an increase in patients being treated in outpatient settings. Those factors made it difficult to determine the magnitude of the readmission rate drop due to the penalty program, MedPAC said [Jordan Rau, “Medicare Punishes 2,499 Hospitals for High Readmissions,” Kaiser Health News, 2021.10.28].
Just one more example of the Affordable Care Act, that South Dakota’s Senators both wanted to repeal, is saving money and improving health care.