Medicare intends to penalize hospitals for giving followup care to seniors

Medicare has announced plans to penalize 2,633 hospitals for giving followup care to seniors, even if the care was appropriate.

Northwestern Memorial in Chicago is the largest hospital in Illinois. It did 1,651 elective hip and knee replacements for Medicare in 2009-2012, and will pay 46% of the revenue from those operations as a penalty.

Froedtert Memorial Lutheran in Milwaukee did 245 replacements and will pay a 96% penalty. Nationwide, 223 hospitals face penalties which are over a fifth of their revenue from hip and knee replacements. Medicare released the new rules with data to estimate these penalties May 15.

The American College of Surgeons warned Medicare last year about "the potential that these hospitals will decrease their care for such patients, thereby creating an access issue." Seniors who cannot get hip and knee replacements lose the mobility they need to stay healthy.

Hospitals pay these penalties if they readmit more seniors within 30 days after discharge than the national average. Hospitals listed here readmitted 7% to 10% of their patients after hip and knee replacements. The national average is 5%.

Medicare treats readmissions above the national average as unnecessary, and penalizes them after hip and knee replacements, pneumonia, heart attacks, heart failure, and chronic obstructive pulmonary disease (COPD). The conditions are so widespread that 81% of hospitals measured will pay penalties. A year ago penalties did not apply to COPD, hip and knee replacements, and Kaiser Health News Aug. 2, 2013 reported that two thirds of hospitals had penalties, which were smaller.

In Philadelphia, Pennsylvania Hospital of the University of Pennsylvania did 1,020 replacements and will pay 57% of that revenue as a penalty.

Parkwest Medical Center in Knoxville did 1,079 replacements and will pay a 31% penalty.

The Medical Center of the University of California at Davis did 226 replacements and will pay a 27% penalty.

Hospitals cannot give up this much revenue, and may need a new business model with less treatment of Medicare patients.

Several studies show that readmissions prevent deaths. The American Hospital Association reported in Trendwatch September 2011, "mortality is inversely related to readmissions."

Doctors Krumholz, Lin and colleagues in the Journal of the American Medical Association Feb.13, 2013 reported a 17% correlation between higher readmissions and lower deaths among heart failure patients. These are the same Yale authors who develop Medicare's readmission data, yet their own hospital cannot avoid readmissions. Yale-New Haven Hospital did 253 replacements and will pay a quarter of that revenue as a readmission penalty.

Doctors Gorodeski, Starling and Blackstone of the Cleveland Clinic showed with a graph in the New England Journal of Medicine July 15, 2010 that hospitals with higher readmissions after heart failure treatment had significantly fewer deaths among the patients.

Doctors Joynt and Jha of Harvard in the Journal of the American Medical Association Jan 23, 2013 found that penalties fall heaviest on hospitals which serve the neediest patients, "large hospitals, teaching hospitals, and SNHs [safety net hospitals] are more likely to receive payment cuts" from readmission penalties, "likely related to both case mix (medical complexity) and socioeconomic mix of the patient population."

Medicare charges these penalties 1-4 years after treatment, even though all the readmissions were fully approved by doctors and Medicare at the time of treatment, and paid for by Medicare.

Many readmissions are random and unrelated to the original hospital care. Medicare's 2014 Specifications Report gives examples of readmissions: severe flu, intestinal infections, burns, a broken arm, accidental poisoning and hundreds more (pp. 57-61). These readmissions vary randomly among hospitals, so the unlucky hospitals each year, or the ones serving fragile patients, are fined simply for being over the US average readmission rate.

If a patient cooks while recuperating, she can burn herself. If she has food delivered, she can get food poisoning. Neither readmission is the hospital's fault, and either can lead to a penalty. To avoid penalties, a hospital may send all patients to nursing homes, at higher cost to Medicare.

Penalties for each readmission above average range from $33,000 for a readmission after COPD treatment, to $285,000 for a readmission after hip or knee replacement.

A list of penalties for every hospital is at Globe1234.com, based on Medicare's data. Medicare will take comments on the readmission penalties until June 30.