Twenty-three Massachusetts hospitals will pay larger penalties to the federal government this year under a Medicare program meant to improve care for some of the sickest seniors, according to an analysis by Kaiser Health News. Another 32 hospitals will see penalties decline.
The program docks pay to hospitals whose patients are most likely to be readmitted within 30 days of treatment for pneumonia, heart failure, or heart attacks. Medicare has increased the stakes this year, doubling the highest possible penalty to 2 percent of a hospital’s Medicare payments. Eighteen hospitals in the United States, none in Massachusetts, will pay that much, reports Jordan Rau of Kaiser Health News.
The readmission penalties have been a sore point among hospitals, which say they unfairly punish those that care for the sickest patients, a debate that Rau expertly explains.
Drs. Karen Joynt and Ashish Jha, researchers at the Harvard School of Public Health, have found that the penalties hid hardest those hospitals that care for poor and minority communities. They have suggested that the penalty is a blunt tool that may consume resources that could be better spent on other patient safety efforts.
“The recognition of just how complex and difficult of a problem this is is growing as people are starting to grapple with it on the ground,’’ Joynt told Rau. “It’s going to take creativity and innovation and most importantly reaching outside the hospital walls.’’
Among those Massachusetts hospitals that last year paid the top penalty of 1 percent, several will see their payments decrease this year. Beth Israel Deaconess Medical Center will pay .69 percent and Tufts Medical Center will pay .85 percent.
Several hospitals will see their penalties increase significantly, by at least a third of a percentage point, when the new program takes effect Oct. 1. They include Carney Hospital, Holyoke Medical Center, Milford Regional Medical Center, Milton Hospital, and Wing Memorial Hospital.
Because the highest possible penalty increased this year, it is possible that some hospitals may pay more even if they lowered readmissions. But sorting that out is tricky, Rau told me in an e-mail, because the Centers for Medicare & Medicaid Services changed how it calculates readmission rates in an effort to exclude planned return trips to the hospital.
This time, [the agency] excluded from its analyses cases where doctors had planned for a second admission. A lung cancer patient, for instance, might be admitted for pneumonia and then return for previously planned chemotherapy. Or doctors might unblock one of a heart attack patient’s arteries and have him come back for a heart pump or previously planned transplant. Medicare estimates that readmissions are planned in 12 percent of heart attack cases, 6 percent of heart failure cases and 4 percent of pneumonia cases.
Nationally, the rate of all readmissions dropped somewhat last winter, according to Medicare, but those changes are too recent to be reflected in this year’s penalties.
(An earlier version of this report incorrectly characterized Mount Auburn Hospital’s performance in the program. The Cambridge facility’s readmission penalty will decrease significantly.)