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BY JIM HALL
Mary Washington Hospital is expected to lose $840,000 in Medicare payments this year because of the hospital's higher than average readmission rates.
The estimated loss equals 1 percent of what Medicare has paid Mary Washington in prior years for select services.
Mary Washington is one of seven hospitals in Virginia to receive the 1 percent reduction, the highest possible penalty under a new Medicare program.
Stafford Hospital and Spotsylvania Regional Medical Center also will be paid less by Medicare, though their readmission rates were better than Mary Washington's and their penalties were smaller.
Spotsylvania Regional is expected to lose $16,000 in Medicare reimbursements this year. Stafford Hospital will lose $11,300.
The cuts took effect Oct. 1 and will continue for one year. They apply to Medicare payments for inpatient services under its traditional fee-for-service program. The penalties will increase in future years if the readmission rates do not improve.
Mary Washington, Stafford and Spotsylvania Regional are among 2,211 hospitals in the United States penalized by the U.S. Centers for Medicare and Medicaid Services. Culpeper Regional, Fauquier Hospital and Sentara Potomac Hospital also were fined.
With these fines, Medicare is telling hospitals to focus on reducing the number of people who return to the hospital within 30 days of discharge.
The idea behind the order is that, with better planning, some readmissions can be prevented, thereby lowering costs and improving care.
The New England Journal of Medicine reported earlier this year that 20 percent of Medicare patients are rehospitalized within 30 days, at an annual cost of $17 billion.
The penalties mean that hospitals receive less money from one of their most important payers. Typically hospitals get about one-fourth of their revenue from Medicare, the federal health program for the elderly and disabled.
The penalties also represent a historic change in the way hospitals are paid, a shift from paying for procedures done to paying for quality care.
Until now, hospitals concentrated on caring for patients while they were in the hospital. Now they'll have to pay more attention to what happens after discharge.
"We have to make sure that the post-hospital care is exacting, appropriate and not left to chance," said Dr. J. Thomas Ryan, executive vice president and chief medical officer for Mary Washington Healthcare.
Under the new rules, hospitals will be expected to work with other providers in the community, such as nursing homes, home health agencies, pharmacies and physicians.
Nancy Littlefield, chief nursing officer for Spotsylvania Regional, compared the new program to an orchestral performance, where community providers work side by side.
"It's a whole redesign in the model of care," she said.
Readmissions occur for a variety of reasons, from premature discharge to failure on the part of patients to do what it takes to stay healthy.
About 25 percent of readmitted patients come from group-care settings such as nursing homes, said Dr. Amy Adome, vice president for quality and patient safety at Mary Washington Healthcare.
"The bulk are coming back from their own homes," Adome added.
This means that hospitals will have to strengthen their existing discharge programs. Mary Washington, for example, phones patients on the day after discharge and every few days after that.
They ask if patients have filled their prescriptions, taken their medicines, obtained the necessary medical equipment, and followed up with their primary care doctors and specialists.
In addition, the caseworker might ask a heart failure patient if he is weighing himself daily, watching fluid intake and monitoring the use of salt.
"Our job is to make sure that they know how important this is," Littlefield said.
Ryan said Mary Washington also has been trying to identify early in the stay if a patient is at risk for readmission.
This could include patients who live alone, those without transportation, or those with multiple health problems, such as diabetes, hypertension and high cholesterol.
"It's care practiced in a different way," Ryan said.
Jim Hall: 540/374-5433
Beginning Oct. 1, Medicare has reduced payments to hospitals whose 30-day readmission rates are higher than average. The rates are calculated as a rolling three-year average, beginning with the period June 2008 to July 2011.
The reductions apply to inpatient care under Medicare's fee-for-service coverage. The program applies to patients hospitalized for pneumonia, heart attack and heart failure. However, the readmission can be for any reason and doesn't have to be at the same hospital.
The maximum fine is 1 percent this year. It will increase to 2 percent next year and 3 percent the year after.
The penalties are included in the Affordable Care Act, the 2010 health care reform legislation.