Updated 10/05/2012 06:10 PM
Medicare readmission penalties start
Most people probably don't want to go to the hospital. And if you've been hospitalized, you probably don't want to go back. But every year patients end up back in the hospital with complications after they've gone home. That's why, as of this week, Medicare is penalizing hospitals if too many patients return within 30 days. As our Katie Gibas reports, the fines mean Upstate New York will lose more than $7.8 million this year.
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UNITED STATES -- If you've been hospitalized, you know that discharge instructions can be complicated.
"It used to be if you came into the hospital, your doctor took care of you and the day you left, your doctor said, 'Time to go home.' Now there's social work. There's case managers. There are physicians, nurses that are assigned to each case and they coordinate being discharged and the list of things we have to be sure are taken care of," said John McCabe, the Upstate University Hospital CEO.
Lawmakers say that patients are too often having to go back to the hospital because of preventable complications. That's why under the Affordable Care Act, Medicare is penalizing hospitals if too many patients come back within 30 days. This year, the fines are up to one percent of a hospital's Medicare payment.
"Many of them don't make money at all. They have negative margins. So anytime there's a hit or a cut of this magnitude, there will be reductions," said Gary Fitzgerald,
That's why hospitals are stepping up their efforts to make sure patients have a successful recovery once they go home. Many hospitals set up follow up appointments, arrange for transportation and educate patients about their prescriptions.
"Every patient that's discharged from this hospital gets a call within a day or two to say, 'how was your stay and are there questions that you have' and if so, they speak to somebody," said McCabe.
But hospitals are worried they'll be penalized for things beyond their control.
"If I send you home and say stay on a low sodium diet for your heart failure and you go home and ignore those rules and I tell you to get these medications filled and you don't go to the pharmacy or follow up with this doctor next week and you don't go, the hospital is the sole place that gets penalized," said McCabe.
Fitzgerald added, "It costs money to put people in the community to follow up with patients obviously, yet if they don't do that, they're going to reduce the amount they get from Medicare, so the hospitals are in a very difficult situation."
And that situation will only get tougher. Next year, the penalties increase to a maximum of two percent.
Some hospitals, including Samaritan in Watertown, Lewis County General in Lowville and Cayuga Medical Center at Ithaca didn't get fined at all.
In Syracuse, the penalties range from 0.2 percent at Upstate University Hospital to one percent at St. Joseph's.
The fines range from no penalty at Wilson Hospital in Johnson City to 0.07 percent at Lordes Memorial in Binghamton to 0.93 percent at Arnot Ogden Medical Center in Elmira.
Medicare Readmission Penalties by Hospital in NYS: