When it comes to the revolving-door syndrome, Florida hospitals are among the best and the worst.
Only two hospitals in the entire nation scored the equivalent of an “A-plus” on a Medicare analysis of readmission rates, and both are in Florida. Meanwhile, this is the only state that had two hospitals flunk all parts of the test.
The analysis of new data on the Hospital Compare website, reported this week by Kaiser Health News, raises a great many questions, such as: Why do the hospitals with high readmission rates sometimes score well on mortality rates? Is there a trade-off?
Analysts disagree. Answers are in short supply. “This thing is extraordinarily complicated," says Rich Morrison, vice president of government affairs for Adventist Health System.
Kaiser Health News' review of readmission scores cited Citrus Memorial of Inverness and Sarasota Memorial as the only hospitals in the nation that outscored all others on readmission rates. They were the only ones that had a significantly better-than-average performance for all three conditions measured: heart attack, heart failure and pneumonia.
Meanwhile, eight hospitals in the country had a significantly worse-than-average return rate for all three conditions. The list includes Haley VA Medical Center in Tampa and Florida Hospital in Orlando, part of the Adventist system.
More than bragging rights are at stake. The Centers for Medicare and Medicaid Services will lower payment rates to hospitals that have higher rates of readmission than the norm beginning Oct. 1.
That’s going to pinch Florida Hospital $3 million in the coming year, said Morrison. “It’s not an insignificant amount,” he said. “It’s critical that we get this fixed.”
The VA hospital receives no payments from Medicare, so it won’t pay an economic penalty for the scores, said Dr. Edward Cutolo , chief of staff. Still, he said, the VA supports the national effort to reduce unnecessary readmissions.
“We want to be above the community standard, certainly not below,” he said.
The readmission rate is what CMS calls the percentage of discharged patients who return to the hospital unexpectedly within 30 days for any cause. While some readmissions are inevitable, health policy experts say they happen far more often than they should.
CMS data showthat about one-fifth of Medicare patients discharged from the hospital return in under 30 days. The bill to Medicare in 2010 was $17.5 billion for inpatient care alone.
A higher-than-average rate of readmissions can indicate that a hospital is sending home patients who aren’t really ready to leave, a practice that can help the bottom line in the Medicare payment system. But a readmission is often a sign of a lack of coordination.
Hospital groups have complained about the penalties, saying they can’t control what happens after patients leave. But CMS hopes the financial incentives will prompt hospitals to find creative solutions.
Officials at both Florida Hospital and Haley said they were chagrined at the readmission scores because they’ve worked really hard to bring them down.
“There’s no single cause that’s making us an outlier,” Morrison said. “it’s a multitude of problems.”
He identified these:
--Some nursing homes send patients back to the hospital at the first sign of anything wrong, without talking to the patient’s doctor or family. Morrison said some nursing homes send a whopping 50 percent of patients back to the hospital within seven days of discharge.
This can become a game of ping-pong, with patients as the balls. Linda S. Ribner of Lauderdale described such a case in a letter published in the South Florida Sun-Sentinel this week with the headline "Why Medicare Is in Trouble." She writes that an 86-year-old relative who lives in an assisted-living facility (ALF) has a medical problem that causes her to fall down several times a month, and each time the ALF sends her to the hospital.
"The hospital has been admitting her, repeating the same tests and x-rays, and keeping her for observation for at least three days at a time," Ribner wrote, "in spite of the fact that she is not seriously injured."
Ribner said her relative has been issued the same neck collar four times. "The bills are astronomical, and the family is powerless to stop this abuse," she said.
Nursing homes have no financial incentive to keep patients from returning to the hospital. If anything, it’s the opposite: Medicare usually doesn’t pay for nursing home care unless there has been a recent hospital discharge.
--Patients need to be seen by their treating physician within days of leaving the hospital, but often they can’t get an appointment for weeks.
Florida Hospital has been “educating” physicians in hopes they’ll change the appointment-scheduling process, Morrison said, but it doesn’t always work. He said Florida Hospital has told doctors that if they can’t get patients in within seven days, the hospital’s medical residents will step in.
--Someone has to check on patients after they leave the hospital, and if there’s not a case-manager at the physician group or health plan who will do it, then hospitals may have to shoulder that role.
--Health News Florida is an independent online publication dedicated to journalism in the public interest. Contact Editor Carol Gentry at 727-410-3266 or by e-mail.
