Central Peninsula Hospital is one of more than 2,000 hospitals across the nation that Medicare has fined for higher-than-average levels of short-term readmission in one of the most common and costly conditions eyed by the federal insurance program.
Although Medicare announced those penalties would start in October — legal under 2010’s new health care law — CPH Chief Executive Officer Rick Davis said the hospital has not been notified directly of the fine it will see as a result of having a higher rate of people readmitted within 30 days for congestive heart failure.
In all, the hospital will likely be fined $6,509 for fiscal year 2013, Davis said. That amounts to about five one-thousands of a percent of the hospital’s annual net revenue, Davis wrote in an email.
The readmission period Medicare studied was from July 2008 to June 2011. In that time, Davis said the hospital had a total of 67 discharges for congestive heart failure, 17 of which were readmitted within 30 days. Of those readmissions, 12 were within the first 18 months of that three-year period.
“In other words we have a (congestive heart failure) patient that is admitted for their fluid management — they come to the ER, they are retaining a lot of water so the ER doctor can’t manage that so they admit them for a couple of days to get their fluid levels back in balance,” Davis said. “Then, if they allow their fluid levels in balance to get out of hand and get readmitted within 30 days, that’s what this represents.”
However, Davis said 12 of those 17 congestive heart failure patients readmitted within 30 days over that period were for conditions other than heart failure, such as a hip fracture, renal disease or gastrointestinal bleeding.
According to Kaiser Health News, Medicare’s effort is part of a push to drive the cost of health care based on quality and not quantity. About one in five, or nearly 2 million, Medicare patients are readmitted nationally within a month of being discharged. That statistic costs the program $17.5 billion annually, Kaiser reported.
The two other conditions the Medicare fines address are pneumonia and heart attack. Three other Alaska hospitals have been fined as well — Alaska Native Medical Center in Anchorage, Mat-Su Regional Medical Center in Palmer and the Yukon-Kuskokwim Delta Regional Hospital in Bethel.
Based on Medicare’s average, CPH had 1.66 more readmissions for congestive heart failure than the national average, Davis said.
Although Davis said the hospital wants to work to improve the health of the community and keep patients from unnecessarily being admitted, he said Medicare’s fine was little more than a “hiccup.”
“With congestive heart failure, basically your heart isn’t pumping blood and over time the arteries narrow and gradually your heart gets too weak to fill and pump efficiently,” Davis said. “It is a lot of lifestyle things, exercise, lowering your salt intake ... managing stress and then medication management is really important because your body starts retaining fluids because your heart isn’t keeping up with your needs.”
Davis said the fine serves to illustrate the area’s lack of resources for cardiology. In larger cities there are clinics and cardiologists that specialize in heart failure. On the Central Kenai Peninsula, that care is placed in the hands of the hospital and primary care physicians, Davis said.
Part of the hospital’s plan for lowering its readmission rate, he said, is ensuring good discharge instructions are given to help patients manage their lifestyle choices, seek primary care provider resources and keep up proper medication management.
“We have a pretty small population of (heart failure) patients on the Peninsula that tend to sort of use the emergency department and the hospital for their primary care, so Medicare is kind of encouraging people to not do that,” Davis said.
Brian Smith can be reached at firstname.lastname@example.org.