April 23, 2018
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As Medicare looks to penalize hospitals for readmissions, some Maine hospitals could be in trouble

By Lindsay Tice, Sun Journal

LEWISTON — Medicare patients discharged from most area hospitals were slightly more likely than others in Maine or across the nation to end up back in the hospital within 30 days, according to a new report.

The one local hospital below the state and national average: St. Mary’s Regional Medical Center in Lewiston. Ironically, it was penalized recently by the federal government for having a separate readmission rate that was too high.

The Robert Wood Johnson Foundation on Monday released a report looking at the readmission rates for Medicare patients who were admitted for medical care or surgery in 2010, the latest year data was publicly available. Nationally, it found 15.9 percent of medical patients and 12.4 percent of surgery patients were readmitted to the hospital within a month — percentages that it said changed little since 2008.

In Maine in 2010, 14.9 percent of medical patients ended up back in the hospital.

At Rumford Hospital it was 18.6 percent. At Central Maine Medical Center in Lewiston it was 17.2 percent. At Franklin Memorial Hospital in Farmington it was 16.1 percent.

In Maine, about 11.9 percent of surgical patients ended up back in the hospital. At CMMC it was 15.3 percent.

Of those listed in the tri-county region, only St. Mary’s was below the state and national average. There 13.4 percent of medical patients and 10 percent of surgical patients were readmitted.

The report also looked at readmission rates for three common illnesses and conditions, but area hospitals had too few of those patients in 2010 for it to calculate a rate, a foundation spokeswoman said. The report also does not list hospitals that have too few patients who meet the criteria for medical care and surgical readmission, which is why only St. Mary’s and CMMC are listed for surgical readmission rates.

Hospitals, government agencies and insurance companies have focused on readmission rates in recent years as concern has grown over patient care and cost. Nearly 2 million Medicare beneficiaries alone are readmitted within 30 days, costing $17.5 billion, according to the federal government.

Last year, Medicare began penalizing hospitals that had too-high readmission rates for Medicare patients with heart failure, heart attack or pneumonia between 2008 and 2011. Franklin Memorial and St. Mary’s were penalized because they each missed the benchmark for one of those categories.

Patient advocates say readmitted patients too often didn’t get the right care the first time, had problems with aftercare instructions, didn’t have proper follow-up care or were discharged too soon. Hospitals say they’re working to change all that.

In recent years, St. Mary’s and CMMC have worked to make sure patients have follow-up care, whether that’s in an aftercare facility or with their family doctor. Both pay close attention to readmission data.

Franklin Memorial evaluated its readmission data and found that more than half happened within 10 days of a patient leaving the hospital. It’s worked to ensure patients understand their medication needs and get a follow-up care, including a call within 48 hours to see how they’re doing. When a patient is readmitted within 10 days now, someone looks into the case to learn what happened and what can be done to prevent such a readmission in the future. Hospital leaders also have daily access to updated readmission numbers so they can keep tabs on how the hospital is faring.

It has helped. A spokesman for Franklin Memorial said readmission for Medicare patients with heart failure, heart attack or pneumonia was in the single digits in 2012, while the national average was closer to 20 percent.

“We’re making some real headway,” said Gerald Cayer, executive vice president of the Franklin Community Health Network, which runs Farmington’s Franklin Memorial Hospital. “So we’re feeling very positive about the path forward.”

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