ROCKPORT, Maine — The new head of Pen Bay Healthcare said steps have been taken to address the high rate of patients who are readmitted to Pen Bay Medical Center after being treated there.
Pen Bay is one of 10 hospitals in Maine being penalized by Medicare for the high rate of readmissions. The Rockport hospital’s penalty is the highest in the state in terms of percentage of payments being withheld by the federally funded health care program.
The monetary penalty for Pen Bay will be $77,590 in 2012-2013, less than one-tenth of 1 percent of revenues received by the hospital.
Medicare is imposing penalties of up to 1 percent starting Oct. 1 for hospitals with greater than acceptable rates for patients who are admitted to the hospital within 30 days of being discharged. The penalty increases to a maximum of 2 percent in October 2013 and up to 3 percent in October 2014.
Wade Johnson, the president and chief executive officer of Pen Bay Healthcare, said Thursday that reducing the readmission rate is one of the hospital’s priorities. Johnson was hired in February to oversee the health care system that includes Pen Bay Medical Center in Rockport, Quarry Hill retirement village in Camden, the Knox Center for Long Term Care in Rockland, Kno-Wal-Lin Home Health Care, and the majority of physician offices in the area.
“There’s no question that Pen Bay sticks out,” Johnson said of the readmission rates.
The rates through 2011 are not listed by the Centers for Medicare and Medicaid but the agency notes that the excess readmission rate is based on factors that are clinically relevant including patient demographic characteristics, multiple medical conditions, and patient frailty. The most recent statistics available from 2007-2010 show that 27.5 percent of patients with heart failures were readmitted within 30 days.
He said a new chief medical officer has been hired. He said David Bachman, who is the senior medical director for transitions of care at Pen Bay’s parent corporation MaineHealth, has been selected for the post. He will begin his duties at the hospital in October.
“We’re fortunate to have him. He’s a brilliant physician,” Johnson said.
Pen Bay also stated in a letter to the editor from PBMC Vice President of Nursing Services Paula Delahanty that the hospital has instituted a risk assessment that could result in a visit by a nurse transition coach when a patient is discharged from the hospital, home health visits, follow-up phone calls, medication education, follow-up visits with the patient’s primary care physician, and connecting the patient with the local area agency on aging.
Medicare analyzes medical records of patients covered by its program for three types of diagnoses — pneumonia, heart attacks and congestive heart failure, Johnson said. Over the past three years ending in July 2011, the readmission rate for Pen Bay has been greater than what Medicare considers acceptable.
The penalty assessed to Pen Bay was 0.72 percent of its Medicare reimbursements. Of the 20 acute-care hospitals in Maine, 10 will be penalized. The next highest penalty rate other than Pen Bay was Mercy Hospital in Portland at 0.29 percent.
Mercy issued a written statement Friday saying the readmission data for Mercy was based on a time when heart failure and heart attack cases were being managed by a private physician practice.
“Since July 2011, when Mercy Cardiology was formed, readmissions are 30 percent less than 2011 and well ahead of our quality goal,” according to the statement from Dr. Scott Rusk, the chief medical officer and vice president of medical administration for Mercy.
The hospital said the integration of Mercy Cardiology, Mercy and VNA based care management staff arrange follow-up appointments and manage high-risk patients.
“This group has exceeded the service and quality goals we envisioned for the group,” Rusk stated.
He noted that the hospital was three admissions per 1,000 patients from not being penalized at all.
The Portland hospital’s medical director said the public should also look at mortality levels and how well Mercy compares to other hospitals.
The other acute-care hospitals in Maine penalized for higher than acceptable readmission rates were Mid Coast Hospital in Brunswick at 0.17 percent, Franklin Memorial Hospital in Farmington and Henrietta Goodall Hospital in Sanford at 0.16 percent, Maine Coast Memorial Hospital in Ellsworth and York Hospital in York at 0.12 percent, Parkview Adventist Medical Center in Brunswick at 0.07 percent, MaineGeneral Medical Center in Augusta at 0.03 percent, and St. Mary’s Regional Medical Center in Lewiston at 0.02 percent.
The standards set by Medicare are reasonable, Johnson said, and fair, noting that all hospitals are being evaluated equally.
Twenty hospitals in Maine are designated as acute care while the remainder are defined as rural critical access hospitals and they are not compensated the same way and are not subject to this readmission penalty, according to Emma Sandoe, a spokeswoman for the Centers for Medicare and Medicaid Services.
Pen Bay Healthcare’s Johnson said he does not want to make excuses because improvements are needed in the transition from a hospital stay to outpatient care but, he added, there are some documentation problems at the hospital that also need to be improved that would likely put the hospital closer to the federal standard for readmissions.
He said medical records are coded and Medicare reviews those codes. If the hospital has not properly coded, the federal agency will not get the most accurate picture. For example, he said if a patient is admitted to the hospital for pneumonia, there is a standard for how long they should be in the hospital and the expected rate of readmission. But if the person has pneumonia and diabetes, he said, that stay and rate might be different.
He said some of the hospital’s documentation has not shown how sick some patients have been which would have skewed the results.
Medicare accounts for more than half the revenues received by the hospital and along with Medicaid accounts for 75 percent of all revenues.
The Congressional Research Service reported that in 2008, Medicare payments for inpatient care totaled $129.1 billion, representing 29 percent of total Medicare payments in that year ($444.9 billion).
Part of the Affordable Care Act approved in 2010 calls for reducing readmissions as a way to save money for the Medicare program.
More than 2,000 hospitals across the country will be penalized under the new standards.
If Medicare actually provided comprehensive medical care for people, or if we had universal healthcare, then readmissions would drop dramatically. This is just another GOP strategy for appearing to reduce spending while passing the cost along to everyone. The people against Universal healthcare just don’t get it. One way or anther we do all pay for healthcare. It would be much more efficient, and thus cost much less, to just implement non-profit Universal healthcare. It would be much better for the patients too.
So true
This is what happens when the government is involved in healthcare. If the hospital kept a patient in until they were well enough to be discharged they would be penalized. Instead, they discharge when the feds say they have to and……surprise, surprise……they end up readmitted. There is NO way the hospital can win. And, no way the patient can win.
The push to discharge patients early came years ago from insurance companies, not the government. The motivation was the old bottom line ie: profits.
Insurance companies are a legalized Mafia. Just wait till Obama Care begins, everyone will finally see the truth. It will not be nice.
It’s already begun and most people love it.What needs to happen is ins.cos.need to be shut down but the crooked R’s won’t like that.
You need to add crooked D’s to your list. Get real.
Thanks to the reporter for illustrating what a small financial penalty is involved. Doing so gives more of a clue that attention must be given to the need for the provision of quality care, not just “any” care, whether in hospital, or at related practitioner offices. “Anycare for all,” is not what is needed.
Maybe if patients weren’t kicked out of the door before they’re healed, they wouldn’t need to go back to the hospital. The excuse is that patients are at a high risk of contracting a hospital based infection if they aren’t tossed out early. But I’ll wager most of the re-admissions have infections and pain control issues.
Glad I don’t have to get my family taken care of there…….wow.
Holding providers and insurers responsible is just one part of the ACA. It is only the beginning of better health more affordably for all the citizens of our country.
Just another way to cause delays in healthcare & to penalize hospitals & doctors. This gawdawful administration will not be happy until we are standing in lines waiting for care.
Seems the hospitals disagree with you as they are trying to fix the problem
The usual lies from your side.
Just one more example of good from the Affordable Care Act
wondering if all the prescription drug seekers are skewing this at all.
tinyurl.com/cyk9xz2
Would the insurance companies have any thing to do with it ?
Having just been horrified by my dad’s readmissions back into Portsmouth Hospital, New Hampshire, I would like to add my humble 2 cents worth, and it has nothing to do with politics, although that does figure into it. The lack of professionalism, cleanliness and simple attention to patients is truly appalling. Medical care has taken a huge step backwards with sanitation. Everyone and anyone can come in, passing along germs. Nurses wear jeans on dress down day?? You got to kidding me? No! What ever happened to having a protected and sanitary environment? And we wonder why people like my dad, now 85 with cancer, has had both merca and Cdif????? Clara Barton would be shocked. Patients are left to wallow in their vomit, and other messes, for hours at a time, and this is suppose to be in a hospital? Sterility and methods to combat this made huge strides in medical care, and in the last 20 yrs has been blown out the window with this very casual atmosphere in hospitals now. No wonder why my dad lasted 2 days in rehab? He had merca, and it was not cleared up. He can hardly address the cancer for all the hospital born infections. And let’s not talk about Medicare and how the govt is dictating his care now. I can’t even get into that nightmare!!!
We will eventually get universal health care, but, oh, how the GOP is going to dislike giving up on the US going to a new WAR every couple of years.
Obama care has increase the cost of care for everyone.
If Medicare paid the actual cost of care instead of what it deems should be the cost of care, hospitals probably wouldn’t be booting patients out too soon to keep from going under.
This is just great- penalizing the hospitals for a problem that Medicare caused in the first place. It all started with the initiation of so-called DRG’s (Diagnostic Related Groups) in the 80’s. Under that system, which was the precursor to today’s reimbursement model, Medicare looked at the national average length of stay for any particular diagnosis to determine how much the hospital would be reimbursed. For example, if somebody had a heart attack the feds would look at how many days the average recovery would take and that was the number of days’ hospitalization Medicare would reimburse, say 5 days. If the hospital could discharge the patient after only 3 days, it made money because it was getting paid for 5. Conversely, if the patient was kept 10 days, the hospital lost money. That was all well and good if the population you were dealing with was young and healthy. Maine, like the nation, has an aging population with much more complex health needs. Additionally, this is a very rural state with a larger than average population of uninsured residents, who also tend to be in a lower socioeconomic class than the rest of the country. Hence, Maine hospitals already operate at a disadvantage. I believe this is only going to get worse under Obamacare because medical decisions are going to be made by bureaucrats, not physicians. Medicare is going broke and, love her or hate her, Sarah Palin was right in her assessment that “yay vs. nay” treatment decisions will fall to bureaucratic “death panels”. Harshly put, perhaps, but true nonetheless.