COLUMBIA MEMORIAL HEALTH got some unwelcome news recently. The federal government plans to punish the hospital for readmitting too many patients, including the poorest of them. The punishment means a little less support for the care of poor patients.
Columbia Memorial spokesman Bill Van Slyke did not have an exact figure this week for how much federal reimbursement the hospital would lose, saying instead that no matter what the amount, “every dollar is critical.” He criticized the withholding of payments related to readmissions as “fundamentally unfair.”
He’s got a point, and yet the policy he’s criticizing is meant to cure problems in hospital care and encourage better health outcomes. It’s also became a little less unfair.
Some of the details are in a Times Union story reprinted this week, which reports that Columbia Memorial faces the largest percentage loss of Medicare reimbursement in the Capital Region. Most, if not all, of the hospitals in the region will also take a hit.
The idea behind these penalties involves patients treated for four kinds major medical problems–acute myocardial infarction; chronic obstructive pulmonary disease; heart failure; pneumonia–and patients who require one of two common surgical procedures–coronary artery bypass graft or elective hip and/or knee replacement. In theory those patients shouldn’t need to return to the hospital as a patient within 30 days after they were originally discharged.
When hospital readmissions at less than 30 days for these patients rises above a certain level, a hospital is targeted by the federal government as not properly managing its care. To encourage the hospital to reduce its readmissions, the federal Centers for Medicare and Medicaid cuts the amount the hospital would normally receive for treating Medicaid and Medicare patients. It’s an incentive program: the more care you provide by readmission, the less money you get. It sounds perverse, but not if the more-care part was avoidable.
A hospital that cuts its readmissions down to what the government thinks is the right number will have its full funding restored in the future.
Making practice of holding hospitals financially responsible for excess readmissions is a part of the Affordable Care Act, a.k.a. Obamacare. The object is to improve care by keeping people out of the hospital not putting them in it. It is also a recognition that improving healthcare outcomes requires support services in the community. In wealthy communities those services exist and patients can afford them. Elsewhere, like Columbia and Greene counties, not so much.
By last year the Centers for Medicare and Medicaid Services realized that all hospitals are not equal. So CMS has now created a five-tiered system that compares readmission rates of hospitals serving similar communities. Columbia Memorial ended up in Tier 5. It is among the hospitals with the highest percentage of patients whose medical care comes totally from Medicare and Medicaid. The poorest of poor patients.
Columbia Memorial can provide medical services and assess the needs a patient when he or she is discharged. The hospital can offer advice about nutrition and provide community assistance contacts. But where, exactly, does the responsibility of the hospital end? CMH has already experimented with forms of mission creep, which hasn’t resolved the readmissions dilemma.
What the readmissions penalty proves is that CMH can’t solve this problem on its own.
That’s borne out by the number of other hospitals that haven’t solved their readmission targets either. And that suggests it takes more than the threat of lower reimbursements to achieve the desired result.
CMH can undoubtedly lower its readmission rate with greater attention to that task. But the hospital has finite resources and you have to wonder what other aspects of CMH services might suffer if reducing readmissions becomes a higher priority.
The penalties the federal government plans to levy on more than 2,600 hospitals nationwide come to $566 million. Even in a more equitable system, that’s a huge amount of money to hold back from healthcare. At the very least each hospital’s share should be redirected to community services in the hospital’s service area to assist people in need to stay out of the hospital.
Our healthcare system is complex beyond belief. There is no magic way to improve it. But this bad news for CMH is a reminder that Obamacare can be flexible and the people running it still care about the fairness of the system. That’s small comfort for CMH right now but it speaks volumes about the importance of preserving Obamacare it as a springboard to more rational and humane healthcare.