18 East Texas hospitals face reimbursement penalization - KYTX CBS 19 Tyler Longview News Weather Sports

EAST TEXAS (TYLER MORNING TELEGRAPH) - Eighteen East Texas hospitals, including East Texas Medical Center and The University of Texas Health Science Center at Tyler, are among the more than 2,200 nationwide that will be penalized by Medicare beginning this week, all in an effort to pay based on performance.

Government officials say Medicare patients are being readmitted to the hospital too soon after discharge, costing the program an additional $17.5 billion annually. It represents about 20 percent of all Medicare spending.

One in five patients nationwide are readmitted to the hospital within 30 days, and under provisions of the Patient Protection and Affordable Care Act, government officials aim to bring those numbers down.

In Texas, excessive readmissions cost the state $32 billion from 2005-2009, according to Texas Department of Health Services estimates.

About two-thirds of all hospitals will face penalties up to 1 percent of its Medicare reimbursements for fiscal year 2013, accounting for a total of $280 million in Medicare funding lost to those hospitals.

For example, if a hospital that is being penalized the maximum 1 percent this year submits a Medicare claim for $10,000, it will receive only $9,900. The maximum amount of the penalty will increase to 2 percent by October 2013 and reach 3 percent by 2014.

The penalties are based on Medicare claims from July 1, 2008 to June 30, 2011. Medicare is focusing on three areas that have the highest rates of readmission: pneumonia, heart attack and heart failure. In the future, hospitals that fare better than average in certain categories will receive bonus Medicare payments.

In Tyler, Texas Spine and Joint Hospital and Mother Frances Hospital will not be penalized in Fiscal Year 2013, according to Center for Medicare and Medicaid Services records.

ETMC's Tyler hospital and seven of its rural hospitals will be hit with a reduction in reimbursement rates. Two of its hospitals —at Henderson and Clarksville —are among the 278 hospitals in the country to have the maximum reduction of 1 percent assessed. ETMC Tyler will see a reduction of .13 percent. The University of Texas Health Science Center at Tyler will see a reduction of .16 percent.

Mother Frances and ETMC are among the East Texas hospitals that have worked with the Texas Hospital Association's Texas Center for Quality and Patient Safety to help reduce hospital admissions.

Through the initiative Project RED, hospitals collaborate with other facilities across the state to share approaches in reducing readmission rates within 30 days of discharge.

Rachel Cicerchi, program manager at the Texas Center for Quality & Patient Safety, said some readmissions are beyond a hospital's control, and that it is a community-wide issue rather than a hospital issue.

In fact, hospitals in rural areas and those that serve the poor may get hit the hardest by the new Medicare adjustments.

"Readmission rates, in general, may not be the best measure of hospital quality due to environmental factors that are beyond the control of hospitals," Rebecca Berkley, ETMC spokesperson, said in a written statement.

"For example, readmission rates don't consider the patient demographic served by the hospital. In general, smaller, more rural hospitals typically serve an older population living in more isolated areas. Readmission rates historically tend to be higher in more remote areas, where the socioecomic status is lower and the population is poorer. Patients in hospitals serving smaller communities tend to not have the access to primary care physicians, and individuals in these areas often do not follow post-discharge instructions very closely."

Mrs. Berkley said all of ETMC's hospitals in the system were aware of this new metric being used by Medicare and expected to be more negatively impacted because of the population it serves. She said ETMC officials are continuing to implement changes.

"One of our improvements is identifying at-risk patients and working closely with them to ensure they adhere to discharge and post-hospital care instructions," she said.

"Also, as ETMC connects all its hospitals into a single electronic health record system, we expect to be able to better monitor the continuum of care for all ETMC patients. This technology will help us communicate better and offer more consistent care at all ETMC facilities and will reduce the chance for medication or other clinical errors."

As a result of the new Medicare adjustments, ETMC is projected to lose $660,000 this year.

East Texas Medical Center – Henderson 1 percent
East Texas Medical Center – Clarksville 1 percent
Good Shepherd Medical Center – Marshall 1 percent
Memorial Hospital – Nacogdoches 1 percent
East Texas Medical Center – Jacksonville .89 percent
East Texas Medical Center – Crockett .72 percent
East Texas Medical Center – Trinity .54 percent
Cozby-German Hospital – Grand Saline .48 percent
Good Shepherd Medical Center – Longview .46 percent
East Texas Medical Center – Athens .30 percent
Woodland Heights Medical Center – Lufkin .29 percent
East Texas Medical Center – Mount Vernon .24 percent
Nacogdoches Medical Center– Nacogdoches .23 percent
The University of Texas Health Science Center at Tyler .16
East Texas Medical Center – Tyler .13
Longview Regional Medical Center –Longview .09
Memorial Health System of East Texas – Lufkin .09
Palestine Regional Medical Center– Palestine .09
Mother Frances Hospital–Tyler 0
Texas Spine and Joint Hospital – Tyler 0
Hopkins County Memorial Hospital – Sulphur Springs 0
East Texas Medical Center – Gilmer 0
Atlanta Memorial Hospital – Atlanta 0
Allegiance Specialty Hospital of Kilgore 0
Titus Regional Medical Center – Mount Pleasant 0

Source: 2013 Medicare readmission penalties, Center for Medicare and Medicaid Services, compiled by Kaiser Health News. No evaluation was available for Mother Frances-Jacksonville and Mother Frances- Winnsboro.