Medicare readmission penalties hit some states harder than others

Kaiser Health News reports that Medicare readmissions penalties are falling hardest on hospitals in New Jersey, New York, Arkansas, Mississippi and the District of Columbia.

Find the article here.

According to KHN, a total of 2,217 hospitals, or 71 percent of those eligible, are receiving penalties for having too many patients with heart attacks, heart failure or pneumonia return within 30 days. Only hospitals with at least 25 heart failure, heart attack or pneumonia cases for Medicare to evaluate were eligible

A total of 307 hospitals received the maximum penalty: a reduction of 1 percent in all of Medicare’s reimbursements for the fiscal year that began Oct. 1.

These new numbers come after CMS found errors in its initial calculations in August. Learn about the recalculations here. 

But the new numbers do not represent significant geographic or demographic shifts.

The revised penalties, like their earlier versions, fall hardest on safety-net hospitals.

KHN divides hospitals into four quartiles, based on how many poor patients they tended to treat. In the quartile of hospitals with the most poor patients, 12 percent received the maximum penalty, and only 20 percent avoided any penalty. By contrast, in the quartile of hospitals with the fewest poor patients, only 7 percent received the maximum penalty, and 33 percent were not penalized at all.

What Drives up Health Care Costs?

There is no one driver and everyone contributes – this according to Kaiser Health News. KHN, in collaboration with the PBS NewsHour reports on a study from the Bipartisan Policy Center, a think tank in Washington, DC which identifies 7 factors associated with health care costs.

The US currently spends more on health care than any other country - $2.6 trillion or about 18% gross domestic product. In 2000 the percentage of GDP was below 15% and by 2020 it is projected to be about 20%.

Here are the 7 factors –

1. We pay our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient.

2. We're growing older, sicker and fatter.

3. We want new drugs, technologies, services and procedures.

4. We get tax breaks on buying health insurance -- and the cost to patients of seeking care is often low.

5. We don't have enough information to make decisions on which medical care is best for us.

6. Our hospitals and other providers are increasingly gaining market share and are better able to demand higher prices.

7. We have supply and demand problems, and legal issues that complicate efforts to slow spending.

Find the article here. 

Find the BPC’s Health Care Cost Drivers Report here. 

The drivers are labeled a bit differently than the 7 drivers presented by the KHN/NPR report, but the drivers are the same and the report has more detail for each.

Find the more detailed BPC study “What Is Driving U.S. Health Care Spending? America’s Unsustainable Health Care Cost Growth” here.

“At a basic level, health spending is a product of the price of health care services and the utilization of those services. The underlying drivers of price and utilization, which in turn are the key drivers of overall health care spending growth in the U.S., are described in this paper.”

2013 National Patient Safety Goals for Hospitals

The Joint Commission has issued its 2013 National Patient Safety Goals for Hospitals.

Find them here.
The purpose of the National Patient Safety Goals is to improve patient safety. As stated by the Commission, the goals focus on problems in health care and how to solve them.

For 2013, the goals include –

Identify patients correctly. NPSG.01.01.01: “Use at least two ways to identify patients. For example, use the patient’s name and date of birth. This is done to make sure that each patient gets the correct medicine and treatment.”

Prevent infection. NPSG.07.01.01: “Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning.”

Second presidential debate focuses little on healthcare

A prominent feature of the first presidential debate, healthcare was barely mentioned in the second of three presidential debates – and the last scheduled to focus on both domestic and foreign policy.  The two candidates focused heavily on other domestic issues such as jobs, taxes, energy, and immigration policy. 

Instead, of discussing it directly, the candidates wove healthcare—albeit slightly—into answers to questions on other topics. For instance, the president mentioned contraceptive coverage under the Patient Protection and Affordable Care Act as well as funding for Planned Parenthood during a discussion of income inequalities between men and women in the workplace.

President Obama argued that Romney “feels comfortable having politicians in Washington decide the healthcare choices that women are making.” 

Obama said that his healthcare bill requires insurance companies to provide contraceptive coverage to everyone who is insured because the issue is not just a health issue, but also an economic one.

"When Gov. Romney says that we should eliminate funding for Planned Parenthood: There are millions of women all across the country who rely on Planned Parenthood for not just contraceptive care, they rely on it for mammograms, for cervical cancer screenings…that's a pocketbook issue for women and families all across the country, and it makes a difference in terms of how well and effectively women are able to work."

Romney said Obamacare has hurt the middle class and deterred small businesses from hiring new employees.  Romney said of Obama and Obamacare that “[Obama] said he'd reform Medicare and Social Security—he hasn't even made a proposal for either one…he said middle-income families would have a reduction in their health insurance premiums, it's gone up by $2,500 a year.”

“If Obamacare is implemented fully, it will be another $2,500 on top. The middle class is getting crushed under the policies of a president who has not understood what it takes to get the economy working again.”

The candidates will meet for the final debate Oct. 22 at Lynn University in Boca Raton, Fla., to discuss foreign policy.

Read the original article from ModernHealthcare.com here. The article requires readers create a free profile for the site.

Safety-Net Hospitals Brace for Cut to Federal Subsidies

Hospitals that treat a disproportionately large number of patients who cannot pay for some or all of their care, known as safety-net hospitals, have relied on subsidies provided by the federal government to help defray costs for more than 20 years. But that funding is set to decline starting in 2014 with the full implementation of the Affordable Care Act, the federal health care reform legislation now known as Obamacare.

The assistance is known as DSH payments, for disproportionate share hospital, and the program is critical to keeping the hospital's finances in the black, said Michael Harristhal, vice president of public policy and strategy at Hannepin County Medical Center in Minneapolis. "That's been a very important part of our total revenue stream," he said.

Harristhal said that the annual revenue for his medical center, Minnesota’s largest safety-net hospital, approaches $700 million, and about $30 million of that comes from the DSH program. Even though those payments amount to less than 5 percent of the hospital's revenue, he said they help Hennepin break even.

The $11 billion DSH program provided $75 million to Minnesota hospitals last year, including children's hospitals in Minneapolis and St. Paul, the University of Minnesota Medical Center and Regions Hospital in St. Paul.

The federal healthcare law won't eliminate DSH payments altogether, but it cuts them by half over five years. The reductions begin in 2014, the same year the law requires most Americans to obtain health insurance or pay a penalty. The theory is that hospitals will need fewer DSH subsidies because they'll be treating a reduced number of patients who lack insurance.

University of Minnesota health economist Lynn Blewett said the state's own history may provide some reassurance to safety net hospitals.

"We did some work a number of years ago with the MinnesotaCare program and saw as MinnesotaCare expanded, levels of uncompensated care were reduced," Blewett said. "So there is some evidence that as you get more people covered, that there should be less need for free care provided by hospitals."

Still, Blewett said, there is great uncertainty about how large a cut Minnesota's safety net hospitals will face.

The law calls for cutting half a billion dollars from the DSH program starting in about a year, but the Obama administration has yet to decide which states will see the largest cuts.

Scott Leitz, the assistant commissioner of Minnesota’s Department of Human Services, said state hospitals will still need help. The department estimates there will be 200,000 people in Minnesota who lack health insurance in 2016, either by choice or through exemptions in the health law. The state may need to reallocate the DSH payments, he said.

"We'll have to make an analysis around who is seeing the uninsured, and are we allocating the dollars today properly or do we need to make any changes," Leitz said.

For now, safety net hospitals can only wait to find out how much of their own safety net will survive.

How does healthcare reform benefit women?

A NAHAM member has asked us to share a recent article, written by Susan Blumenthal, M.D., public health editor at the Huffington Post and former U.S. Assistant Surgeon General. A summary of the article can be found below, but you may also view the full article and Dr. Blumenthal’s profile here.

Dr. Blumenthal writes that women have historically experienced discrimination in terms of their health – despite making 80 percent of health care decisions for their families, using more medical services than men, and suffering greater disability from chronic disease.  

Here is what has changed – “Just 20 years ago, women's health was neglected in the halls of public policy, at the research bench, and in clinical settings in America.”

Pointing to the Patient Protection and Affordable Care Act of 2010 (most commonly referred to as Obamacare), Dr. Blumenthal says the new law has given women “access to comprehensive, quality health care”. 

She writes – “In fact, 19 million women in America do not have health insurance. Women are more likely to lose their insurance if divorced or widowed, and often paid more for premiums than did men. Thanks to the recent passage of the Patient Protection and Affordable Care Act of 2010 (recently upheld by the Supreme Court), all of this will change.”

Dr. Blumenthal also cites several significant improvements “to ensure an efficient, effective, and equitable health care system for women -- and men -- over the life cycle.”

Currently, only 50 percent of women have employer-sponsored insurance compared to 57 percent of men.  Obamacare eliminates gender rating on premiums.

Obamacare also allows children up to age 26 to be included on their parents.  (“As a result of this provision in the new law, 1 million young women now have health insurance.”)

Women can no longer be denied coverage for pre-existing conditions like cancer, asthma, or depression.

Under its "Patient's Bill of Rights,"Obamacare prevents insurance companies from instituting lifetime benefit caps, dropping patients who file reimbursement claims, and spending more than 20 percent of premium payments on administrative costs.

The expansion of Medicaid under Obamacare will bring more women into the healthcare system through coverage.  Dr. Blumenthal writes that currently “two-thirds of Medicaid beneficiaries are women, and the majority of the 55 percent of uninsured women who have incomes below 138 percent of poverty will now qualify for Medicaid coverage in 2014.”

Furthermore, women with incomes between 139 percent and 399 percent of the poverty level will be eligible for tax-credits towards the purchase of insurance plans.

Meningitis Outbreak: 75 facilities affected

NPR has reported that 75 medical facilities received a potentially contaminated drug suspected of infecting 47 patients with meningitis nationwide. A list of those facilities can be found here.

The hospitals and clinics that have used the possibly tainted steroid are located in 23 states, from New Hampshire to California and Idaho to Florida. The Centers for Disease Control and Prevention has released the facility names and phone numbers so that patients who have had spinal injections at these facilities will know if they're at risk for a rare and dangerous kind of meningitis.

The number of meningitis cases went up by 12 last Friday, October 5^th, but the number of deaths remained stable at five. The CDC says all 42 known survivors are still hospitalized, and officials expect more cases to emerge over the coming weeks.

The CDC urges patients who have received steroid injections in the past month to seek immediate care if they have headaches, fever, nausea, dizziness, slurred speech or confusion. Many who have received the potentially contaminated drug have escaped harm, however, and others have had only mild symptoms.

Close to 18,000 doses of the drug, methylprednisolone acetate, have been recalled by the Massachusetts pharmacy that made it. The drug is used to treat back pain.

NPR’s article can be found here.

Study: Many Seniors’ ER Visits Could Be Avoided

A congressional advisory board report released Friday, October 5^th, found that many emergency room visits by seniors could be avoided. The study, reported by Kaiser Health News, found that nearly 60 percent of Medicare beneficiary visits to emergency rooms, and 25 percent of their hospital admissions, were “potentially preventable,” had patients received better care at home or in outpatient settings.

Hospitals spent $30.8 billion on 4.4 million hospital admissions in 2006 that might have been avoidable, according to a report by the federal Agency for Healthcare Research and Quality. Data like this is why researchers have been looking at reducing preventable ER visits and hospital admissions for years. This study is one of the first large analyses of Medicare patients. The study analyzed health services provided to 5 percent of all traditional Medicare program beneficiaries from 2006 to 2008.

“These are spectacular rates,” said Scott Armstrong, a member of the Medicare Payment Advisory Commission and CEO of Group Health Cooperative, a Seattle-based health plan.

The potentially preventable admissions or ER visits do not indicate the hospital acted inappropriately. Instead, they are a measure of a community’s outpatient care system that includes private physician offices, community health centers and urgent care centers, study co-author Nancy Ray, a MedPAC principal policy analyst, told the congressional advisory board. Ray said not every preventable ER visit or admission can be avoided. The study showed wide variation of these rates across the country and within cities.

Patients could avoid preventable ER visits by having health conditions treated by family doctors or urgent care centers or by making sure to take all their medicine. Hospital admissions could be prevented if conditions such as asthma, diabetes or heart failure were better monitored by patients and their doctors, commission staff said.

The full report can be found here, and the Kaiser article can be found here.

Government developing a consumer rating system for health information

A rating system for patient health information was announced in a Federal Register on Friday, October 5^th, 2012. The Agency for Healthcare Research and Quality (AHRQ), a division of the Department of Health and Human Services (HHS,) is asking that the system be approved.

Focusing on concerns of patient “health literacy” – the notice says –

Persons with limited health literacy face numerous health care challenges. They often have a poor understanding of basic medical vocabulary and health care concepts. A study of patients in a large public hospital showed that 26 percent did not understand when their next appointment was scheduled and 42 percent did not understand instructions to “take medication on an empty stomach.” In addition, limited health literacy leads to more medication errors, more and longer hospital stays, and a generally higher level of illness, resulting in an estimated excess cost for the US health care system of $50 billion to $73 billion per year

According to the notice, the agency's Health Information Rating System will focus especially on patient data provided by electronic health records. This material is “rarely written in a way that is understandable and actionable for patients with basic or below basic health literacy.” This group of patients includes about 77 million people according to a ModernHealthcare.com article found here. These people “often have a poor understanding of basic medical vocabulary and healthcare concepts.”

Agency officials expect the rating system to address the challenge of conveying information to patients by giving clinicians a method to determine the quality of the data their systems provide, or even to inform them that such resources are available.

A draft version of the rating system was applied by researchers at AHRQ to sample education materials on asthma and colonoscopy and indicated some of the material had “low understandability or low actionability.” The agency plans to next use consumer panels to test the accuracy of the rating system.

The Federal Register announcement can be found here, and is open to public comment until December 4, 2012.

Answer This Question

What mandatory signage should be visible in public areas of your hospital?

The requirements are similar across the country, but it is important to understanding specific hospital and state requirements in order to be in full compliance.

One NAHAM member shared these –

1. Inpatient Room & Services Charges

2. Infection Control Guidelines (“cover your cough”)

3. Patient Rights & Responsibilities (multiple languages)

4. HIPAA Notice of Privacy Practice (multiple languages)

5. Financial Assistance Information

6. Hospital License

7. State Public Health Department Contact Information

What signage do you make available in public areas, such as your registration area?

Is anything missing from the list above?

Do you post any signage not in the list?

Send us any resources, guidance or educational material that can guide others in determining what signage to make available in their public areas and in their registration areas.

You can also provide input when you are in the toolkit with an easy-to-use comment form.

NAHAM’s Joint Commission Toolkit is available to all NAHAM members.

If you haven’t yet, you should check out NAHAM’s new Toolkit for Joint Commission surveys. The toolkit features a preparedness checklist and series of question sets – all organized around the disciplines NAHAM members all know and respect.

Go to www.naham.org and select “Government Relations” on the sidebar and then select “Joint Commission Survey Toolkit”. You will need your NAHAM Username and Password.

Healthcare: Fact Checking the Debate

News outlets examined a range of issues brought up during last night's presidential face-off, ranging from discussions of the $716 billion Medicare cut to talk of death panels and whether the health law promise of lower health insurance costs came true.  Kaiser Health News compiled the list of news sources and summary of their fact checking findings.

The Washington Post: Fact Check: The $700B Medicare Cut
Romney accused Obama of taking $716 billion from Medicare. This $700 billion figure comes from the difference over 10 years (2013-2022) between anticipated Medicare spending (what is known as "the baseline") and the changes that the law makes to reduce spending. The savings mostly are wrung from health-care providers, not Medicare beneficiaries — who, as a result of the health-care law, ended up with new benefits for preventive care and prescription drugs. While it is correct that anticipated savings from Medicare were used to help offset some of the anticipated costs of expanding health care for all Americans, it does not affect the Medicare trust fund. In fact, the Obama health-care law also raised Medicare payroll taxes by $318 billion over the new 10-year time frame, further strengthening the program’s financial condition (Kessler, 10/3).

Los Angeles Times: Fact Check: Romney's Charge On Obama's $716-Billion Medicare Cut
Mitt Romney repeated a somewhat misleading claim that President Obama cut $716 billion out of the Medicare program for current beneficiaries. The president's healthcare law does reduce future spending on Medicare, but those savings are obtained by reducing federal payments to insurance companies, hospitals and other providers, and do not affect benefits for people in the Medicare program (Levey, 10/3).

Los Angeles Times: Fact Check: Romney Repeats Erroneous Claims On Healthcare
Mitt Romney repeated a number of erroneous claims during Wednesday's debate about President Obama's healthcare law, including that it relies on a board that will decide "what kind of treatment" patients can get. This is a myth advanced repeatedly by critics of the Affordable Care Act and debunked consistently by independent fact-checkers (Levey, 10/3).

Los Angeles Times: Presidential Debate: It Always Comes Back To The 'Death Panels'
Just what to do with the nation's healthcare system has been argued time and again – but it always seems to come back to the "death panels." Such was the case at the debate in Denver on Wednesday night, when moderator Jim Lehrer asked the candidates whether Obamacare, one of the most contentious issues this election season, should be repealed (Semuels, 10/3).

Politico: Debate Fact Check: Analyzing Health-Care Statements
President Barack Obama and Mitt Romney had at it out over health care Wednesday night — providing some of the toughest, and wonkiest, moments of the night. Both candidates also showed they had done their research, citing studies to back their claims about Obama's health care law and how the other would cut Medicare spending — but they both managed to stretch the truth (Nather and Kenen, 10/4).

The Washington Post: About That Unelected Medicare Board

Just how will the IPAB work? Its powers kick in only if federal spending on Medicare exceeds yearly targets set by the law. At that point the board must propose spending cuts. Congress could overrule the panel, but only if it musters a super-majority in the Senate, or comes up with an alternate plan that saves at least as much (Aizenman, 10/3).

NPR: Romney Goes On Offense, Pay For It In First Wave Of Fact Checks
Has the president put in place a plan that would cut Medicare benefits by $716 billion? Romney says yes. The president says no. According to PolitiFact, Romney's charge is "half true." … In listing his objections to the Affordable Health Care Act, Romney said it "puts in place an unelected board that's going to tell people, ultimately, what kind of treatments they can have. I don't like that idea."  But the Times and National Journal have reported that the board in question wouldn't make treatment decisions, a point Obama made during the debate. National Journal called Romney's characterization of what this board would do "one of the biggest whoppers of the night" (Memmott and Montgomery, 10/4).

The New York Times: Check Point: Taking Stock Of Some Of The Claims And Counterclaims
Mitt Romney repeatedly questioned President Obama's honesty at Wednesday night's debate — likening the president and vice president at one point to his five sons repeating things that were not true — but he made a number of misleading statements himself on the size of the federal deficits, taxes, Medicare and health care (Cooper, Calmes, Lowrey, Pear and Broder, 10/4).

Los Angeles Times: Fact Check: 'Obamacare' Hasn't Yet Reduced Health Insurance Costs
President Obama reiterated a claim that his healthcare law will reduce costs, a promise he made when he started pushing for an overhaul as a candidate four years ago. Then, Obama said he would cut family health insurance premiums by $2,500 by the end of his first term. Today, this stands as one of the president’s biggest unfulfilled promises. In fact, the average employee share of an employer-provided health plan jumped from $3,515 in 2009 to $4,316 in 2012, an increase of more than 22%, according to a survey from the Kaiser Family Foundation and the Health Research & Educational Trust (Levey, 10/3).

CNN: Fact Check: Would Repeal Of Obamacare Hike Seniors' Drug Costs?
President Barack Obama said the repeal of Obamacare would cause seniors' prescription drug payments to rise. "We were actually able to lower prescription drug costs for seniors by an average of $600," Obama said during his debate with GOP challenger Mitt Romney. He went on to say that if Obamacare were repealed, "those seniors right away are going to be paying $600 more in prescription care." Nearly 5.4 million Medicare recipients saved more than $4.1 billion on prescription drugs as a result of the Affordable Care Act, Health and Human Services Secretary Kathleen Sebelius said in an August news release. "Seniors in the Medicare prescription drug coverage gap known as the 'donut hole' have saved an average of $768," she said. The law helps make Medicare prescription drug coverage more affordable (10/4).

Medicare Revises Hospital Readmission Penalties

As previously reported by NAHAM News, the Centers for Medicare and Medicaid Services (CMS) are modifying the way in which hospitals are being reimbursed for services performed for Medicare patients. As part of the Affordable Care Act (ACA), known in this campaign season as Obamacare, or more generally as healthcare reform, hospital reimbursement rates will be modified based on their readmission rates. The basis for the program is the fact that nearly one in five Medicare patients return to the hospital within a month of discharge, costing the government an extra $17.5 billion in 2010. The original article from NAHAM News can be found here.

Since our first report, CMS has discovered errors in its initial reimbursement calculations in August, however. As a result, 1,422 hospitals with comparatively high readmission rates will lose slightly more money than they were expecting, according to a Kaiser Health News analysis of the revised penalties. Fifty-five hospitals will lose less than they were previously told.

The full article from KHN can be found here. Kaiser Health News had also published the penalties for all hospitals, and has since updated their PDF chart and downloadable csv file with the corrected readmission penalties.

The changes were mostly small, averaging two-hundreds of a percent of a hospital’s regular Medicare reimbursements. The largest changes affect Florala Memorial Hospital in Florala, Ala., which will see its penalty increase from 0.62 percent to 0.73 percent of its reimbursements, and Western Pennsylvania Hospital in Pittsburgh, which will see its penalty drop from 0.51 percent to 0.4 percent.

Kaiser Health News reports that a total of 2,217 hospitals are being punished in the first year of the program and of those, 307 will be docked the maximum amount of 1 percent of their regular Medicare reimbursements.

While CMS alters the rates, many providers and hospital administrators are still questioning the fact that the program ties readmission rates with reimbursement rates. The penalties are not popular among most hospitals since they don’t get any extra payments for efforts to reduce readmissions. In addition, the hospital industry has complained that Medicare doesn’t do an adequate job of distinguishing between necessary and planned readmissions and ones that could have been avoided. Experts say many of these readmissions are unavoidable given the infirmity of the population, but others are due to surgical mistakes or lapses in patient care after patients leave the hospital.

And KHN reports that “hospitals have been preemptively increasing their efforts to cut back on return customers. Some make sure patients get follow-up appointments and take their medication after they return home. Others send nurses to visit patients at high risk of return at home.”  In a related story, KHN features how networks between hospitals and local clinics and providers can also address the readmission issue.  Find that article here.

Feds Want 1,000 Rural Hospitals on EHRs By 2014

Electronic Health Records (EHRs) have been phased into practice in many major metropolitan hospitals, due in large part to support from the Obama administration, but this technology may be harder to find in rural communities. In an attempt to rectify that, the U.S. government is funneling as much as $30 million through its Regional Extension Center (REC) program. The money is part of an effort to get 1,000 federally designated "critical access hospitals" and small, rural hospitals to adopt electronic health records (EHRs) and achieve Meaningful Use by 2014. These funds could help up to 1,501 rural hospitals.

This money is in addition to the $32 million in funding that the Office of the National Coordinator for Health Information Technology (ONC) previously committed to RECs to help health IT adoption at Critical Access Hospitals. Critical Access Hospitals are defined as rural facilities with no more than 25 beds and an average daily census of 10 or fewer patients. The ONC officials said that about 1,220 Critical Access Hospitals and other small acute care facilities have signed up for REC assistance.

The Kansas City, Mo.-based National Rural Health Association (NRHA), which represents this class of hospitals, is on board with the plan but still sees obstacles ahead. "Generally, NRHA is very pleased to see ONC making this push. We think it's been overdue," said Brock Slabach, NRHA senior VP for member services. However, Slabach says he will be reserving judgment until he sees ONC's baseline tally for small hospitals that have already met Meaningful Use. ONC will allow NRHA to work with the Centers for Medicare and Medicaid Services (CMS)--the "keeper of the data," according to Slabach--to calculate the baseline.

The short timeline to get to Meaningful Use before penalties begin Oct. 1, 2014--the start of federal fiscal year 2015, which Medicare Part A follows--means that hospitals need to get started on EHR implementation in the next year or so.

Find the full article from InformationWeek’s Health Care section here.