The Newnan Times-Herald


Local hospitals hit with medicare penalties

  • By Melanie Ruberti
  • |
  • Oct. 03, 2018 - 12:06 AM

Local hospitals hit with medicare penalties

Courtesy of Piedmont Newnan

Piedmont Newnan Hospital

More than 85 percent of Georgia’s hospitals are set to be penalized by Medicare – and two of those facilities are in Coweta County.

Piedmont Newnan Hospital and the Cancer Treatment Centers of America are on the current list for reportedly readmitting too many of their patients within a month of their discharge, according to recently released federal data.

CTCA was listed as the Southeastern Regional Medical Center on the document, but was listed under the same address as CTCA.

Of the 100 Georgia hospitals evaluated for penalties, 82 received the Medicare fines during the current fiscal year.

Nationally, Medicare will subtract payments to 2,599 hospitals throughout fiscal year 2019, which begins Oct. 1, according to federal records. 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 a hospital’s handling of Medicare patients. On orders from Congress, Medicare is easing up on its annual readmission penalties on hundreds of hospitals serving the most low-income residents, according to Kaiser Health News.

The change in the penalty formula for safety-net hospitals came after these hospitals argued that their patients are more likely to suffer complications after leaving the hospital because they cannot afford medications or don’t have regular doctors to monitor their recoveries.

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 state hospitals “provide high-quality care to all patients, regardless of their ability to pay.’’

James added 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 said.

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.

The Centers for Medicare & Medicaid Services (CMS) this year also stopped judging each hospital against all others. Instead, it assigned hospitals to five peer groups of facilities with similar proportions of low-income patients.

Medicare then compared each hospital’s readmission rates from July 2014 through June 2017 against the readmission rates of its peer group during those three years to determine if they warranted a penalty and, if so, how much it should be.

On average, penalties against safety-net hospitals will drop by one-fourth from last year, the KHN analysis found.

Since the sanctions began, Medicare has annually evaluated the rates of readmitted patients who had originally been treated for heart failure, heart attacks and pneumonia. The evaluations have since expanded to cover chronic lung disease, hip and knee replacements and coronary artery bypass graft surgeries.

Medicare counts discharged patients who are hospitalized again within 30 days. If the second admission is at a different hospital from the one that discharged the patient, the penalty is applied against the first hospital.

Congress’ Medicare Payment Advisory Commission concluded in June that the penalties from previous years succeeded in pressuring hospitals to reduce the numbers of returning patients – and helped save Medicare about $2 billion a year, KHN reported.

The penalty concept is being expanded. This fall, Medicare will start issuing fines on nursing homes that send recently discharged residents back to the hospital too frequently.

The Newnan Times-Herald will continue to follow this story with comments from local hospitals affected by the latest round of Medicare penalties.