Hospitals will pay up for preventable readmissions

Medical centers crow about their ranking on those “best hospital” lists. They use billboards and magazine ads to talk up their “highly rated” “top” docs, but hospitals won’t be bragging about their inclusion on a new health-quality ranking from the federal government.

It lists facilities that have to pay up because they have too many “bounce backs” — patients readmitted after an inpatient stay.

The Affordable Care Act and federal regulators at the Centers for Medicare and Medicaid Services are pushing hospitals to lower the numbers of preventable readmissions. In October, hospitals will begin paying a penalty for an excessive number of Medicare patients readmitted within 30 days.

See the penalties for our area »

“CMS needs to remember that people are not cars,” said Curt Schroder, head of the Delaware Valley Healthcare Council, the region’s hospital association. “They seem to be treating hospitals like auto repair shops, in other words, ‘You should be able to change the tire, send them on their way and not see them for another 5,000 miles.'”

Schroder says the federal government is using an equation that doesn’t adequately account for the challenges faced by safety-net hospitals that care for many low-income and minority patients. Those patient populations have documented higher rates of readmission, he said.

Some hospitalizations can’t be avoided

Hospitals across the region have formed working groups, piloted programs and generally worked hard to cut down on avoidable readmissions. But experts say some hospitalizations are simply unavoidable.

“My view is that in the current state of the American health-care system, a 30-day readmission is not a hospital metric, a 30-day readmission rate is a health system metric,” said Dr. P.J. Brennan.

Brennan, the chief medical officer for the University of Pennsylvania Health System, said hospitals are trying to keep their arms around patients after discharge, but a patient’s personal finances, health literacy and access to primary care are beyond the control of any individual institution.

“No patient should be readmitted within seven days. Seven days is something that every hospital ought to be able to take care of,” Brennan said. “At some point, other factors begin to impact.”

At Penn Medicine, executives think additional home-care services can keep some patients out of the hospital, but Brennan says many people decline the extra help.

At first Brennan thought older patients were, perhaps, hesitant to have strangers in their home.

“When we got underneath it a little further, we discovered that the patients were turning it down, primarily, because they had co-pays for every visit in the home, and they didn’t want to incur expenses for those visits,” Brennan said. “In a situation like that, our hands are tied, a little.”

Penalties added impetus for follow through

Coy Smith is vice president for patient-care services and chief nursing officer at Wilmington’s St. Francis Hospital.

“We are looking at better handoffs to home care, skilled nursing facilities, better discharge preparation of patient families and using home care as an avenue to really track them. Because it’s the right thing to do, truly,” Smith said. “But having these penalties over our head does kind of make a difference.”

The new penalties are based on data for three health conditions: heart attack, heart failure and pneumonia. Smith said St. Francis has lowered readmission rates for all three categories in the last 18 months, but the new ranking use historical three-year data from 2008 to early 2011.

The maximum readmission penalty is 1 percent of a hospital’s Medicare reimbursement.

St. Francis is facing a 0.66 percent penalty. Temple University gets dinged with 0.49 percent less money. Thomas Jefferson University’s fine is 0.57 percent. Cooper University Hospital in Camden will lose 0.96 percent.

“These regulations present some challenges that are concerning,” said a statement from Cooper Hospital. “The penalty applies to “all-cause” readmissions within 30 days – so if the patient develops a problem unrelated to the reason for the initial admission that requires hospital care, the penalty may still apply. It also includes readmissions to other facilities, meaning that if the patient presents to another ER or hospital for care, the penalty applies, even if the original facility/physician isn’t notified or even aware, and so may not have the opportunity to intervene to prevent that readmission.”

Philadelphia’s three Penn Medicine hospitals, which are within walking distance of one another, face wide-ranging fines: The Hospital of the University of Pennsylvania — 0.02 percent; Penn Presbyterian Medical Center — 0.06 percent; Pennsylvania Hospital — the full 1 percent.

“It shows that it’s a lot more than geography,” Brennan said.

What does it signify for patients?

Kerry McKean Kelly, spokeswoman for the New Jersey Hospital Association, said it’s not clear yet if publishing the readmission penalties will be helpful for patients.

“So what we always recommend to consumers is that you just take, not just a single source of health-care data but get as much information as possible to get a full picture of the quality of health care,” Kelly said.

Brennan said hospitals agree they need to shift the way they do business and take wider responsibility for patients once they leave, but the question is “how much responsibly?”

Hospital executives and other care-quality hawks continue to debate what readmissions are avoidable and which are not.

The federal government is upping the ante soon. In 2013 the maximum readmission penalty increase to 2 percent of each center’s Medicare reimbursements.

Taunya English’s story is part of a project on health in the states a partnership of WHYY, NPR and Kaiser Health News.

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[‘Bayhealth – Kent General Hospital’,’Dover’,’Del’,.32],
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[‘Atlanticare Regional Medical Center – City Div’,’Atlantic City’,’N.J.’,.56],
[‘Bayonne Hospital Center’,’Bayonne’,’N.J.’,1.00],
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[‘Bergen Regional Medical Center’,’Paramus’,’N.J.’,.36],
[‘Cape Regional Medical Center Inc’,’Cape May Court House’,’N.J.’,.61],
[‘Capital Health Medical Center – Hopewell’,’Pennington’,’N.J.’,.50],
[‘Capital Health System-fuld Campus’,’Trenton’,’N.J.’,.38],
[‘Centrastate Medical Center’,’Freehold’,’N.J.’,1.00],
[‘Chilton Hospital’,’Pompton Plains’,’N.J.’,.27],
[‘Christ Hospital’,’Jersey City’,’N.J.’,1.00],
[‘Clara Maass Medical Center’,’Belleville’,’N.J.’,.78],
[‘Community Medical Center’,’Toms River’,’N.J.’,.72],
[‘Cooper University Hospital’,’Camden’,’N.J.’,.96],
[‘Deborah Heart And Lung Center’,’Browns Mills’,’N.J.’,.98],
[‘East Orange General Hospital’,’East Orange’,’N.J.’,1.00],
[‘Englewood Hospital And Medical Center’,’Englewood’,’N.J.’,.36],
[‘Hackensack University Medical Center’,’Hackensack’,’N.J.’,1.00],
[‘Hackettstown Regional Medical Center’,’Hackettstown’,’N.J.’,.84],
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[‘Holy Name Medical Center’,’Teaneck’,’N.J.’,1.00],
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[‘Mountainside Hospital’,’Montclair’,’N.J.’,.19],
[‘Newark Beth Israel Medical Center’,’Newark’,’N.J.’,1.00],
[‘Newton Memorial Hospital’,’Newton’,’N.J.’,.60],
[‘Ocean Medical Center’,’Brick’,’N.J.’,.69],
[‘Our Lady Of Lourdes Medical Center’,’Camden’,’N.J.’,.55],
[‘Overlook Hospital’,’Summit’,’N.J.’,0],
[‘Palisades Medical Ctr-ny Presbyterian Healthcare S’,’North Bergen’,’N.J.’,1.00],
[‘Raritan Bay Medical Center’,’Perth Amboy’,’N.J.’,1.00],
[‘Riverview Medical Center’,’Red Bank’,’N.J.’,.58],
[‘Robert Wood Johnson University Hospital’,’New Brunswick’,’N.J.’,.81],
[‘Robert Wood Johnson University Hospital At Rahway’,’Rahway’,’N.J.’,1.00],
[‘Robert Wood Johnson University Hospital Hamilton’,’Hamilton’,’N.J.’,.97],
[‘Saint Barnabas Medical Center’,’Livingston’,’N.J.’,.21],
[‘Saint Clare’s Hospital’,’Denville’,’N.J.’,.70],
[‘Saint Clare’s Hospital/sussex’,’Sussex’,’N.J.’,.38],
[‘Saint Michael’s Medical Center, Inc’,’Newark’,’N.J.’,1.00],
[‘Saint Peter’s University Hospital’,’New Brunswick’,’N.J.’,1.00],
[‘Shore Medical Center’,’Somers Point’,’N.J.’,.20],
[‘Somerset Medical Center’,’Somerville’,’N.J.’,.85],
[‘South Jersey Healthcare Regional Medical Center’,’Vineland’,’N.J.’,.17],
[‘South Jersey Healthcare-elmer Hospital’,’Elmer’,’N.J.’,.08],
[‘Southern Ocean Medical Center’,’Manahawkin’,’N.J.’,.17],
[‘St Francis Medical Center’,’Trenton’,’N.J.’,1.00],
[‘St Joseph’s Regional Medical Center’,’Paterson’,’N.J.’,1.00],
[‘St Luke’s Warren Hospital’,’Phillipsburg’,’N.J.’,.39],
[‘St Mary’s Hospital, Passaic’,’Passaic’,’N.J.’,1.00],
[‘Trinitas Regional Medical Center’,’Elizabeth’,’N.J.’,.72],
[‘Umdnj University Hospital’,’Newark’,’N.J.’,.58],
[‘Underwood – Memorial Hospital’,’Woodbury’,’N.J.’,1.00],
[‘Univ Medical Center Of Princeton At Plainsboro’,’Plainsboro’,’N.J.’,.24],
[‘Valley Hospital’,’Ridgewood’,’N.J.’,1.00],
[‘Virtua Memorial Hospital Of Burlington County’,’Mount Holly’,’N.J.’,.10],
[‘Virtua West Jersey Hospitals Berlin’,’Berlin’,’N.J.’,.71],
[‘Abington Memorial Hospital’,’Abington’,’Pa.’,.32],
[‘Acmh Hospital’,’Kittanning’,’Pa.’,0],
[‘Advanced Surgical Hospital’,’Washington’,’Pa.’,0],
[‘Albert Einstein Medical Center’,’Philadelphia’,’Pa.’,.54],
[‘Alle Kiski Medical Center’,’Natrona’,’Pa.’,1.00],
[‘Allegheny General Hospital’,’Pittsburgh’,’Pa.’,.31],
[‘Altoona Regional Health System’,’Altoona’,’Pa.’,.01],
[‘Aria Health’,’Philadelphia’,’Pa.’,1.00],
[‘Berwick Hospital Center’,’Berwick’,’Pa.’,.63],
[‘Bloomsburg Hospital’,’Bloomsburg’,’Pa.’,.75],
[‘Bradford Regional Medical Center’,’Bradford’,’Pa.’,.04],
[‘Brandywine Hospital’,’Coatesville’,’Pa.’,0],
[‘Bucks County Specialty Hospital’,’Bensalem’,’Pa.’,0],
[‘Butler Memorial Hospital’,’Butler’,’Pa.’,.87],
[‘Cancer Treatment Centers Of America’,’Philadelphia’,’Pa.’,0],
[‘Canonsburg General Hospital’,’Canonsburg’,’Pa.’,.02],
[‘Carlisle Regional Medical Center’,’Carlisle’,’Pa.’,.12],
[‘Chambersburg Hospital’,’Chambersburg’,’Pa.’,0],
[‘Chester County Hospital’,’West Chester’,’Pa.’,.13],
[‘Chestnut Hill Hospital’,’Philadelphia’,’Pa.’,1.00],
[‘Clarion Hospital’,’Clarion’,’Pa.’,.48],
[‘Clearfield Hospital’,’Clearfield’,’Pa.’,1.00],
[‘Community Medical Center’,’Scranton’,’Pa.’,0],
[‘Conemaugh Valley Memorial Hospital’,’Johnstown’,’Pa.’,.34],
[‘Coordinated Health Orthopedic Hospital’,’Bethlehem’,’Pa.’,0],
[‘Crozer Chester Medical Center’,’Upland’,’Pa.’,.57],
[‘Delaware County Memorial Hospital’,’Drexel Hill’,’Pa.’,.55],
[‘Doylestown Hospital’,’Doylestown’,’Pa.’,0],
[‘Dubois Regional Medical Center’,’Dubois’,’Pa.’,0],
[‘Eagleville Hospital’,’Eagleville’,’Pa.’,0],
[‘Easton Hospital’,’Easton’,’Pa.’,1.00],
[‘Edgewood Surgical Hospital’,’Transfer’,’Pa.’,0],
[‘Elk Regional Health Center’,’Saint Marys’,’Pa.’,.61],
[‘Ellwood City Hospital’,’Ellwood City’,’Pa.’,.30],
[‘Ephrata Community Hospital’,’Ephrata’,’Pa.’,.14],
[‘Evangelical Community Hospital’,’Lewisburg’,’Pa.’,0],
[‘Excela Health Frick Hospital’,’Mount Pleasant’,’Pa.’,1.00],
[‘Excela Health Latrobe Hospital’,’Latrobe’,’Pa.’,.27],
[‘Excela Health Westmoreland Regional Hospital’,’Greensburg’,’Pa.’,.59],
[‘Geisinger Medical Center’,’Danville’,’Pa.’,.02],
[‘Geisinger Wyoming Valley Medical Center’,’Wilkes Barre’,’Pa.’,.04],
[‘Gettysburg Hospital’,’Gettysburg’,’Pa.’,.08],
[‘Gnaden Huetten Memorial Hospital’,’Lehighton’,’Pa.’,.16],
[‘Good Samaritan Hospital’,’Lebanon’,’Pa.’,.03],
[‘Grand View Hospital’,’Sellersville’,’Pa.’,.14],
[‘Grove City Medical Center’,’Grove City’,’Pa.’,0],
[‘Hahnemann University Hospital’,’Philadelphia’,’Pa.’,.86],
[‘Hanover Hospital’,’Hanover’,’Pa.’,0],
[‘Hazleton General Hospital’,’Hazleton’,’Pa.’,1.00],
[‘Heart Of Lancaster Regional Medical Center’,’Lititz’,’Pa.’,0],
[‘Heritage Valley Beaver’,’Beaver’,’Pa.’,.77],
[‘Heritage Valley Sewickley’,’Sewickley’,’Pa.’,.23],
[‘Highlands Hospital’,’Connellsville’,’Pa.’,.41],
[‘Holy Redeemer Hospital And Medical Center’,’Meadowbrook’,’Pa.’,.32],
[‘Holy Spirit Hospital’,’Camp Hill’,’Pa.’,.22],
[‘Hospital Of Univ Of Pennsylvania’,’Philadelphia’,’Pa.’,.02],
[‘Indiana Regional Medical Center’,’Indiana’,’Pa.’,.73],
[‘J C Blair Memorial Hospital’,’Huntingdon’,’Pa.’,.01],
[‘Jameson Memorial Hospital’,’New Castle’,’Pa.’,1.00],
[‘Jeanes Hospital’,’Philadelphia’,’Pa.’,.64],
[‘Jefferson Regional Medical Center’,’Pittsburgh’,’Pa.’,.45],
[‘Jennersville Regional Hospital’,’West Grove’,’Pa.’,1.00],
[‘Kane Community Hospital’,’Kane’,’Pa.’,.75],
[‘Kensington Hospital’,’Philadelphia’,’Pa.’,0],
[‘Lancaster General Hospital’,’Lancaster’,’Pa.’,0],
[‘Lancaster Regional Medical Center’,’Lancaster’,’Pa.’,.29],
[‘Lansdale Hospital’,’Lansdale’,’Pa.’,.65],
[‘Lehigh Valley Hospital’,’Allentown’,’Pa.’,.23],
[‘Lehigh Valley Hospital – Muhlenberg’,’Bethlehem’,’Pa.’,.51],
[‘Lewistown Hospital’,’Lewistown’,’Pa.’,1.00],
[‘Lock Haven Hospital’,’Lock Haven’,’Pa.’,0],
[‘Lower Bucks Hospital’,’Bristol’,’Pa.’,.72],
[‘Magee Womens Hospital Of Upmc Health System’,’Pittsburgh’,’Pa.’,.04],
[‘Main Line Hospital Bryn Mawr Campus’,’Bryn Mawr’,’Pa.’,.55],
[‘Main Line Hospital Lankenau’,’Wynnewood’,’Pa.’,.30],
[‘Main Line Hospital Paoli’,’Paoli’,’Pa.’,0],
[‘Marian Community Hospital’,’Carbondale’,’Pa.’,1.00],
[‘Meadville Medical Center’,’Meadville’,’Pa.’,.03],
[‘Memorial Hospital York’,’York’,’Pa.’,1.00],
[‘Memorial Hospital, Inc Towanda’,’Towanda’,’Pa.’,0],
[‘Mercy Fitzgerald Hospital’,’Darby’,’Pa.’,1.00],
[‘Mercy Suburban Hospital’,’Norristown’,’Pa.’,.19],
[‘Millcreek Community Hospital’,’Erie’,’Pa.’,.85],
[‘Milton S Hershey Medical Center’,’Hershey’,’Pa.’,0],
[‘Miners Medical Center’,’Hastings’,’Pa.’,0],
[‘Monongahela Valley Hospital’,’Monongahela’,’Pa.’,.56],
[‘Montgomery Hospital’,’Norristown’,’Pa.’,.24],
[‘Moses Taylor Hospital’,’Scranton’,’Pa.’,.03],
[‘Mount Nittany Medical Center’,’State College’,’Pa.’,.28],
[‘Nason Hospital’,’Roaring Spring’,’Pa.’,.46],
[‘Nazareth Hospital’,’Philadelphia’,’Pa.’,1.00],
[‘Ohio Valley General Hospital’,’Mckees Rocks’,’Pa.’,.32],
[‘Oss Orthopaedic Hospital’,’York’,’Pa.’,0],
[‘Palmerton Hospital’,’Palmerton’,’Pa.’,.35],
[‘Penn Presbyterian Medical Center’,’Philadelphia’,’Pa.’,.06],
[‘Pennsylvania Hosp Of The Univ Of Pa Health Sys’,’Philadelphia’,’Pa.’,1.00],
[‘Phoenixville Hospital’,’Phoenixville’,’Pa.’,1.00],
[‘Physician’s Care Surgical Hospital’,’Royersford’,’Pa.’,0],
[‘Pinnacle Health Hospitals’,’Harrisburg’,’Pa.’,.01],
[‘Pocono Medical Center’,’East Stroudsburg’,’Pa.’,0],
[‘Pottstown Memorial Medical Center’,’Pottstown’,’Pa.’,1.00],
[‘Punxsutawney Area Hospital’,’Punxsutawney’,’Pa.’,.33],
[‘Reading Hospital Medical Center’,’Reading’,’Pa.’,0],
[‘Regional Hospital Of Scranton’,’Scranton’,’Pa.’,0],
[‘Riddle Memorial Hospital’,’Media’,’Pa.’,.48],
[‘Robert Packer Hospital’,’Sayre’,’Pa.’,.52],
[‘Roxborough Memorial Hospital’,’Philadelphia’,’Pa.’,1.00],
[‘Sacred Heart Hospital’,’Allentown’,’Pa.’,0],
[‘Saint Catherine Medical Center Fountain Springs’,’Ashland’,’Pa.’,.10],
[‘Saint Vincent Health Center’,’Erie’,’Pa.’,0],
[‘Schuylkill Medical Center – East Norwegian Street’,’Pottsville’,’Pa.’,1.00],
[‘Schuylkill Medical Center – South Jackson Street’,’Pottsville’,’Pa.’,.29],
[‘Shamokin Area Community Hospital’,’Coal Township’,’Pa.’,.66],
[‘Sharon Regional Health System’,’Sharon’,’Pa.’,.28],
[‘Soldiers And Sailors Memorial Hospital’,’Wellsboro’,’Pa.’,0],
[‘Somerset Hospital’,’Somerset’,’Pa.’,.02],
[‘Southwest Regional Medical Center’,’Waynesburg’,’Pa.’,.36],
[‘St Clair Memorial Hospital’,’Pittsburgh’,’Pa.’,.72],
[‘St Joseph Medical Center’,’Reading’,’Pa.’,.07],
[‘St Joseph’s Hospital’,’Philadelphia’,’Pa.’,.71],
[‘St Luke’s Hospital Bethlehem’,’Bethlehem’,’Pa.’,.92],
[‘St Luke’s Miners Memorial Hospital’,’Coaldale’,’Pa.’,.16],
[‘St Luke’s Quakertown Hospital’,’Quakertown’,’Pa.’,.02],
[‘St Mary Medical Center’,’Langhorne’,’Pa.’,.56],
[‘Sunbury Community Hospital’,’Sunbury’,’Pa.’,1.00],
[‘Surgical Institute Of Reading’,’Wyomissing’,’Pa.’,0],
[‘Surgical Specialty Center At Coordinated Health’,’Allentown’,’Pa.’,0],
[‘Temple University Hospital’,’Philadelphia’,’Pa.’,.49],
[‘Thomas Jefferson University Hospital’,’Philadelphia’,’Pa.’,.57],
[‘Titusville Hospital’,’Titusville’,’Pa.’,.37],
[‘Tyler Memorial Hospital’,’Tunkhannock’,’Pa.’,0],
[‘Uniontown Hospital’,’Uniontown’,’Pa.’,.19],
[‘Upmc Bedford’,’Everett’,’Pa.’,0],
[‘Upmc Hamot’,’Erie’,’Pa.’,0],
[‘Upmc Horizon’,’Greenville’,’Pa.’,.01],
[‘Upmc Mckeesport’,’Mc Keesport’,’Pa.’,.68],
[‘Upmc Mercy’,’Pittsburgh’,’Pa.’,.45],
[‘Upmc Northwest’,’Seneca’,’Pa.’,.26],
[‘Upmc Passavant’,’Pittsburgh’,’Pa.’,.19],
[‘Upmc Presbyterian Shadyside’,’Pittsburgh’,’Pa.’,.03],
[‘Upmc St Margaret’,’Pittsburgh’,’Pa.’,.13],
[‘Valley Forge Medical Center And Hospital’,’Norristown’,’Pa.’,0],
[‘Warren General Hospital’,’Warren’,’Pa.’,0],
[‘Washington Hospital, The’,’Washington’,’Pa.’,.41],
[‘Wayne Memorial Hospital’,’Honesdale’,’Pa.’,.20],
[‘Waynesboro Hospital’,’Waynesboro’,’Pa.’,.27],
[‘Western Pennsylvania Hosp Forbes Regional Campus’,’Monroeville’,’Pa.’,.76],
[‘Western Pennsylvania Hospital’,’Pittsburgh’,’Pa.’,.51],
[‘Westfield Hospital’,’Allentown’,’Pa.’,0],
[‘Wilkes-barre General Hospital’,’Wilkes-barre’,’Pa.’,0],
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2013 Medicare Readmissions Penalties By Hospital (Pa., N.J., Del.)
The federal government wants hospitals to lower the number of patients who “bounce back” after a hospital stay. In October, some medical centers will begin paying a penalty for an excessive number of patients readmitted within 30 days. The maximum penalty is 1 percent of the hospital’s Medicare reimbursement. (Data compiled by Kaiser Health News from Centers for Medicare & Medicaid data.)