Many hospitals are being penalized when Medicare patients are readmitted too soon

Hospitals can receive Medicare penalties if too many of their patients are readmitted within a month of their discharge. And recently released federal data show that 85 percent of such facilities in Georgia are set to be penalized.

The readmission penalties, created by the Affordable Care Act, have brought increased scrutiny to the care of patients after discharge.

This coming year’s levies, though, reflect a major change in how safety-net hospitals are evaluated. On orders from Congress, Medicare is easing up on its annual readmission penalties on hundreds of hospitals serving the most low-income residents, Kaiser Health News reported.

The Georgia percentage of hospitals to be penalized is similar to the current rate. Of the 100 Georgia hospitals evaluated for penalties, 82 received the fines during the current fiscal year.

Nationally, Medicare will subtract payments to 2,599 hospitals throughout fiscal 2019, which begins Oct. 1, a Kaiser Health News analysis of federal records found. The government estimates the hospital industry will lose $566 million in the latest round of penalties over the next 12 months.

The readmission penalties apply only to hospitals’ handling of Medicare patients. But critics of the program say the financial loss to a hospital can have repercussions for all patients.

Ethan James of the Georgia Hospital Association said hospitals in the state “provide high-quality care to all patients, regardless of their ability to pay.’’ And he told Georgia Health News that the readmission penalties “are devastating to hospitals’ ability to continue to provide that care, especially because Georgia has one of the highest uninsured populations in the country.’’

Readmissions also occur among many uninsured patients, who lack access to medications and regular care, James added.

The harshest penalty is 3 percent lower reimbursements for every Medicare patient discharged. The number of hospitals and the average penalty — 0.7 percent of each payment — are almost the same as last year, Kaiser Health News noted.

Chestatee Regional Hospital in Dahlonega, recently closed in a complicated business transaction, is the only Georgia facility listed as receiving the maximum penalty.

Among Middle Georgia hospitals, Houston Medical Center received the harshest penalty, at 2.84 percent. That’s followed by Perry Hospital at 1.18 percent; Coliseum Medical Centers at 0.69 percent; Coliseum Northside Hospital at 0.67 percent; Medical Center, Navicent Health, at 0.51 percent; and Navicent Health Baldwin at 0.47 percent.

The data show that 15 Georgia hospitals will have no readmission levy. These include Murray Medical Center in Chatsworth; Gwinnett Medical Center in Lawrenceville; Tift Regional Medical Center in Tifton; St. Francis Hospital in Columbus; Fairview Park Hospital in Dublin; and Piedmont Mountainside in Jasper.

Not all hospitals are subject to the penalties. Medicare exempts facilities that have too few cases, those serving veterans, children and psychiatric patients, and small “critical-access” hospitals.

For more Georgia health news, go to www.georgiahealthnews.com.

This story was originally published September 28, 2018 at 10:47 AM with the headline "Many hospitals are being penalized when Medicare patients are readmitted too soon."