August 14, 2012

Medicare readmissions could bring fines

By Betty Adams
Staff Writer

AUGUSTA -- A nonprofit news group that monitors the health care industry has calculated that MaineGeneral Medical Center -- along with hundreds of other hospitals across the country, including 10 in Maine -- will be fined for readmitting too many Medicare recipients within 30 days of their hospital discharge.

Kaiser Health News estimated that the hospital, which has campuses in Augusta and Waterville, will forfeit 0.03 percent of its Medicare billing beginning Oct. 1.

However, an official at the local hospital said Monday she is not sure whether the hospital will actually receive a penalty.

Lisa Simm, administrative director for Quality Care Management at MaineGeneral, said Medicare is expected to announce in October which hospitals will be fined.

"None of us has gotten our Medicare data yet," she said, adding that some in-house calculations showed that the hospital's rate should be zero, and in that case no fine would be levied. Other calculators show a .03 percent, "which is about as close to zero as you can get," Simm said.

"I don't even have a ballpark figure," Simm said Monday. "We're hoping it will be zero because I've seen a couple of calculations before Kaiser's and they were zero." She had yet to receive the annual Medicare reimbursement figure from the hospital's finance department.

Simm said federal regulators tracked three years' worth of readmissions of Medicare patients who were originally admitted with congestive heart failure, pneumonia or a heart attack. She estimated that involved about 100 patients.

A lot of factors go into why a patient would be readmitted to the hospital, she said. "We know there are things at the hospital we can probably do and there are also support systems within the communities," she said.

The Kaiser Health News story by Jordan Rau says, "With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system."

Simm said the MaineGeneral Medical Center has already signed on with Partnership for Patients, a federally sponsored public-private organization that aims to prevent patients from getting sicker or acquiring illnesses while they're hospitalized and preventing complications that get them readmitted within 30 days.

"We know that readmissions are a problem and we will continue to work on it," Simm said.

Betty Adams -- 621-5631


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