Five of Florida's major public and non-profit hospitals scored so poorly on return rates for Medicare patients that they will get preference this summer in a grant program to fix the problem, government documents show.
They are Shands-Jacksonville, Florida Hospital System in Orlando, Miami’s Jackson Health System, Memorial Regional in Hollywood and Orlando Regional. All scored in the bottom 25 percent of state hospitals on “re-admissions."
This means too many of the Medicare patients they discharged were readmitted a few days or weeks later to the same or another hospital. Federal officials see this as an indication that the patients may have been discharged too soon or without adequate plans for follow-up. It’s as if these hospitals had revolving doors.
Federal officials said they identified the hospitals with the highest readmission rates in order to assure they get preference when grants are handed out later this summer to find effective strategies that address the problem.
“The thinking is that they have the most room for improvement,” said Donald McLeod, press officer at the Centers for Medicare and Medicaid Services.
Three smaller hospitals that also fell in the bottom quartile on all measures—heart attack, heart failure and pneumonia -- were Health Central in Ocoee, Hialeah Hospital and Palm Springs General, also in Hialeah.
“It’s an interesting list,” said Rich Morrison, vice president for government affairs at Florida Hospital. It’s especially puzzling since his health system generally rates high on quality measures for cardiac care; are they reviving patients, only to have them get worse after being sent home?
“We’ve been looking at these issues for the past year,” he said. “We’re not sure what it means.”
Maybe patients aren’t getting the proper instructions when they’re released, or maybe they’re having trouble getting in to see the doctor for follow-up. Maybe the patients aren’t bothering to show up or get prescriptions filled. Maybe they can’t afford to fill them.
Maybe hospitals are sending patients home to situations where they have no one to care for them. Or maybe they’re going to nursing homes that aren’t doing all they should be.
What this exercise shows is the lack of coordination in the U.S. health care system, said Linda Quick, president of the South Florida Hospital and Healthcare Association.
“This is historically a chronic problem that the system of episodic care creates for patients and facilities,” she said. “People go home and have no real incentive to be compliant with instructions they get from physicians or institutions and they end up returning, needing additional attention."
CMS posted the list quietly in March on its web site, in a section describing a demonstration project that would be funded by the Patient Protection and Affordable Care Act. The project, called the Community Based Care Transition Program, invites organizations to form partnerships with hospitals to improve follow-up for discharged patients so that the readmission rate can be lowered.
The data used for the file cover hospitalizations of Medicare patients from July 2006 through June 2009, CMS' McLeod said. They are the same data used for the profiles in the Hospital Compare web site, and they are adjusted for severity of disease of patient populations.
The hospitals that scored in the bottom quartile on this list will suffer no financial consequences, he said. However, in 2013 CMS will begin a new phase in health reform, the Hospital Readmissions Reduction Program (HRRP), which will lower payments to hospitals that have high bounce-back rates.
The American Hospital Association is concerned that this change will hurt hospitals that attract patients from low-income minority communities. In a letter this month to CMS Administrator Donald Berwick, AHA President Richard J. Umbdenstock wrote:
"Congress established the HRRP to create a financial incentive for hospitals treating Medicare beneficiaries to reduce preventable readmissions. The presumption underlying the program is that readmissions most commonly occur due to a hospital's inadequate care and follow-up.
"But there is another critical factor at play...(R)esearch from both the government and private sector shows that African-American patients in
general have a higher risk of readmission and that hospitals serving disproportionately large numbers of minorities have higher readmission rates across the board. Given these facts, a hospital may end up being penalized under the HRRP simply for serving large numbers of minority patients rather than for actually providing poor quality care."
--Carol Gentry, Editor, can be reached at 727-410-3266 orby e-mail.
