Pen Bay Medical Center working to cut down high readmission rates after Medicare penalty

Pen Bay Medical Center in Rockport
Stephen Betts | BDN
Pen Bay Medical Center in Rockport Buy Photo
By Stephen Betts, BDN Staff
Posted Aug. 25, 2012, at 11:27 a.m.

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.

http://bangordailynews.com/2012/08/25/health/pen-bay-medical-center-working-to-cut-down-high-readmission-rates-after-medicare-penalty/ printed on September 17, 2014