CHEYENNE – Laramie County’s largest hospital will again receive a lower Medicare reimbursement due to high readmission rates.
Cheyenne Regional Medical Center was one of nine Wyoming hospitals penalized by the federal government for an “excessive” number of discharged patients returning to a hospital within 30 days.
In an effort to reduce billions in health-care costs, the Affordable Care Act allows Medicare officials to reduce a hospital’s funding based on its rate of readmission, patient infections or patient injuries in a given year.
“It’s a value-based purchasing withhold,” said Jeffrey Chapman, chief medical officer at CRMC. “It’s not a cut. The program gives you an increase in funding if you do really well, too.”
CRMC will receive a 1.26 percent reduction, according to a Kaiser Health News review of Centers for Medicare and Medicaid Services data, higher than the 0.71 percent it was docked last year. (The cap is 3 percent.) Jackson’s St. Johns Medical Center had the highest penalty at 2.82 percent, and Casper’s Mountain View Regional in Casper will lose 1.54 percent.
Chapman said CRMC receives about $54 million in Medicare payments for acute inpatient care annually.
Complications from heart attacks, heart failures, pneumonia, chronic obstructive pulmonary disease, hip and knee replacements and open-heart surgeries were among the reasons for readmittance nationwide.
A recent study conducted by the Dartmouth Atlas Projects and funded by the Robert Wood Johnson Foundation suggests staff shortages, poor communication and hospital financial pressures may all influence these rates.
But Wyoming Hospital Association President Eric Boley said that while hospital leadership is always working to reduce re-entry, the program is flawed.
“No matter how hard we try, it puts all of the liability on the facilities and doesn’t do anything to create ownership for the patient,” he said. “If you have a non-compliant patient who doesn’t follow up or properly follow discharge instructions, you can have a lot of different things that play into the rate.”
The program doesn’t consider health-care nuances, he said; some patients are readmitted for complications unrelated to their previous visit.
“It’s kind of like when you go to get your car fixed,” Boley said. “While you’re there, the mechanic tells you they found other things that need to be replaced. Health care is even more complicated, but this would still fall under this readmission criteria.”
Chapman said there’s more than one way to measure a hospital’s success.
“The numbers are relevant, but they’re difficult,” he said.
“If someone is discharged from our hospital and, for example, goes to Arizona for the winter and is admitted there, we get dinged with the readmission.”
Staff is working to achieve positive patient outcomes through a task force called the Transitions Across Community Team, he said.
“We’re trying to identify people at risk of being readmitted,” he said. “We have a team of nurses who go out and see these patients, if they are agreeable. This is something that we’re very focused on, both from a financial standpoint, but more for how we improve the value of the care we deliver.”