Area hospitals face Medicare reimbursement cuts

Readmission rate standard from Affordable Care Act will become effective in October

More than 70 Tennessee hospitals will this fall be paid less by Medicare because too many of their patients have been readmitted within 30 days.

Researchers at Kaiser Health News recently tallied the Medicare statistics for hospitals nationwide. The regulators' cuts, which will be effective Oct. 1, are part of the implementation of the 2010 Patient Protection and Affordable Care Act. Medicare looked at 30-day readmission rates for Medicare patients and will dock hospitals up to 1 percent of their reimbursements if they fall short of various standards. (See KHN's main story here and the raw Centers for Medicare and Medicaid Services numbers here.)

In all, more than 2,000 hospitals across the country are subject to the ACA’s readmission penalty. Of those, 72 are in Tennessee. In the Nashville area, four hospitals, Centennial Medical Center, Metro Nashville General, NorthCrest Medical Center and the Center for Spinal Surgery, will continue to be paid at their current rates. Fifteen hospitals will have to absorb cuts of between 0.03 percent — Williamson Medical Center — and the full 1 percent — Middle Tennessee Medical Center in Murfreesboro and Gateway Medical Center in Clarksville. Download the full Middle Tennessee data set here.

Locally, there’s a mixed reaction. As expected, organizations created to oversee professional groups find this level of intrusive control unsettling.

Tennessee Hospital Association CEO Craig Becker isn’t surprised by Kaiser’s findings. Becker said hadn’t read the report but his organization has, at least since January, been compiling similar numbers and to similar result. The THA in January acquired a government contract to basically analyze the state’s problem with these readmissions and come up with solutions. So Becker isn’t surprised at the CMS numbers, but he does think some things are being overlooked.

“People forget there are good reasons for someone to be readmitted to the hospital,” Becker said. “Especially those suffering with psychiatric-based issues or those with cardiac challenges.”

Becker’s point is that these conditions, by their very diagnosis and nature, lead to readmission.

“My mother suffers from dementia and recently had to be readmitted for forgetting to follow the instructions she received from the hospital and fell, again, and broke her hip, again,” Becker said. “And it wasn’t the hospital’s fault.”