Dozens of hospitals in Indiana, including several in the Indianapolis area, will see their Medicare reimbursements reduced in the coming year due to their readmission rates, Indianapolis Business Journal (IBJ) reports.
A hospital’s readmission rate – like the number of medical malpractice claims filed against its doctors – can reveal much about the quality of care that the hospital provides to its patients. If a hospital has a high number of readmissions, it may indicate that its patients are not getting the initial care and treatment they need, or that the hospital is falling short when it comes to providing follow-up care.
That is why the federal government, as part of the Affordable Care Act, now reduces Medicare reimbursements to hospitals based on the rate of patients who are readmitted within 30 days after their discharge, IBJ explains.
In the 2019 fiscal year, which began October 1, a total of 66 hospitals in Indiana will face penalties due to their readmission rates, or 80 percent of the state’s medical facilities. The total amount of the penalties will top $12.5 million.
More than half of the hospitals in the country will be penalized as part of the program, or a total of 2,599 facilities, according to IBJ. Indiana ranked No. 29 in the country for the percentage of hospitals penalized.
The federal government bases the Medicare penalties on readmissions which occurred between July 2014 and July 2017, according to IBJ. They include Medicare patients who were initially treated for conditions such as pneumonia, chronic lung disease, heart failure and heart attacks, or who underwent procedures such as coronary artery bypass surgeries or hip or knee replacements.
Four Indianapolis Area Hospitals Among State’s Highest Penalized Hospitals
As IBJ reports, four hospitals in the Indianapolis area were among the 20 hospitals with the highest Medicare penalties due to their readmission rates. Community Hospital North of Indianapolis topped that list with a 1.56 percent penalty – the fifth-highest in the state.
Community Hospital of Anderson and Madison County in Anderson and Witham Health Services in Lebanon tied for the 12th-highest penalties in the state at 1.09 percent. St. Vincent Regional Hospital in Anderson, with a 0.83 percent penalty, had the 19th-highest penalty in Indiana. IBJ noted that St. Vincent Health’s Indianapolis campus and its Carmel heart center were not penalized.
Kentuckiana Medical Center in Clarksville had the highest Medicare penalty in the state at 3.0 percent, which is the maximum penalty that a hospital can face, according to IBJ.
Do Medicare Penalties Help to Improve Quality of Patient Care?
Whether the Medicare penalties help to improve the quality of care that patients receive is a subject of debate. For instance, in order to avoid the penalties, some hospitals may simply change their coding and label patients as being “observed” instead of “readmitted.” That does little to benefit patients.
On the other hand, many hospitals have changed their practices in an effort to truly reduce their readmission rates. As IBJ notes, many hospitals now send patients home with detailed discharge instructions and, in some cases, a month’s worth of medication. They may also send nurses and aides to visit patients in their homes and check on their status.
Our Indianapolis Medical Malpractice Attorneys Can Help You
Patients may have a claim for medical malpractice as a result of a premature discharge due to a failure to timely diagnose or appropriately treat a condition during a hospital visit that resulted in a serious or permanent injury.
At Baker & Gilchrist, we support any program that helps patients to get the care and treatment they need – when they need it. To discuss how we can help you if you or a loved one has suffered harm due to suspected negligent medical care, contact us today. We will provide a free and confidential consultation.