Oregon hospitals haven’t escaped the wrath of Medicare penalties by the Centers for Medicare and Medicaid Services for having too many patients return within a month. In fact, 18 hospitals will see their Medicare reimbursements decline in 2015 – seven of them are located in the Portland metropolitan area – with Oregon Health & Science University leading the list.
All told, Oregon hospitals will lose an estimated $1,886,292 in 2015 from Medicare admissions and an estimated $1,440,886 this year – a sizeable chunk of money.
Only 11 hospitals were fined by CMS in 2014, and, once again, OHSU topped the penalty line up. The teaching hospital that had $297,066,975 in Medicare inpatient discharge revenue during 2013 can expect to lose $534,720 in 2015, and another $445,600 this year. These dollar amounts represent lower payments for every Medicare patient admitted between Oct. 1, 2014 and Sept. 30, 2015.
The four Legacy hospitals in Oregon also came up short, according to the analysis conducted by The Lund Report. The top loser was Legacy Good Samaritan Medical Center, which will see a net decrease of $375,083 in Medicare payments next year representing a 0.35% loss, compared to $107,167 this year.
All 4 Legacy Hospitals Penalized
On the other side of the river, Legacy Emanuel Medical Center expects to lose $170,571 in both years – a 0.19% loss, while both Legacy Meridian Park and Legacy Mt. Hood will see much smaller revenue decreases -- $19,248 and $8,319 respectively in 2015 and $250,236 and $20,798 this year.
Meanwhile, a much smaller and remote hospital, Bay Area Medical Center in Coos Bay with 126 beds, faces the highest percentage penalty in both years -- $260,505 in 2015 (0.50%) and $323,0277 this year (0.62%).
Three hospitals penalized in 2014 escaped fines next year, according to the report -- Providence Willamette Falls Medical Center, Sky Lakes Medical Center and St. Alphonsus Medical Center in Ontario
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To calculate the financial penalties hospitals are paying due to excessive Medicare readmission, The Lund Report used the databank data made available at Oregon.gov to derive Medicare inpatient revenue, then multiplied the Medicare inpatient revenue by the penalty percentage provided by Kaiser Health News to arrive at a final monetary penalty for each hospital. The net inpatient revenue was calculated using 2013 calendar year data, the most recent and complete year of data, and the 2014 and 2015 readmission penalties applied to the calculated 2013 net revenue.
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Of the 11 hospitals that paid a penalty in 2014, seven reduced their penalty percentage from 2014 to 2015: Bay Area Hospital, Legacy Meridian, Providence Willamette Falls, Santiam Memorial, Sky Lakes, Legacy Mount Hood, and St. Alphonsus. Three hospitals increased their penalty percentage: OHSU, Legacy Good Samaritan, and Providence Newberg, and one hospital remained steady: Legacy Emanuel.
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The average percentage penalty in 2014 is 0.18% and 0.12% in 2015.
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In dollars, the largest penalty payer is OHSU with $445,600 in 2014 and is projected to remain the highest payer in 2015 with $534,720 in penalties.
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The average monetary penalty in 2014 is $131,000 per hospital while the projected average for 2015 is $72,600 per hospital.
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In 2015, other hospitals also fined include Adventist Medical Center, Mid-Columbia Medical Center, Mckenzie-Willamette Medical Center, Providence Medford Medical Center, Willamette Valley Medical Center, Providence Newberg, Good Samaritan Regional Medical Center, Asante Three Rivers Medical Center, Mercy Medical Center, Santiam Memorial Hospital, Sacred Heart Medical Center and Tuality Community Hospital.
OHSU Has Highest Medicare Revenue
In terms of Medicare inpatient revenue, OHSU is far and away the highest income producer, with $297 million in 2013, followed by Providence St. Vincent Medical Center with $209 million, Salem Hospital, $206 million, Sacred Heart Medical Center in Riverbend with $202 million, and Providence Portland Medical Center with $185 million.
On the very low end of the scale, Asante Rogue Regional Medical Center received $17 million, Silverton Hospital, $19 million and Providence Newberg Medical Center, $20 million.
When asked about the Medicare penalties for Oregon hospitals, Philip Schmidt, director of public affairs for the Oregon Association of Hospitals and Health Systems, told The Lund Report: “Readmissions continues to be a strategic priority for our members. Work continues on improvements in this area and we are completing a 2-year ‘Partnership for Patients’ program on focusing on just this.”
Across the nation, 2,610 hospitals were penalized after the program was created under federal healthcare reform to reduce preventable readmissions.
The fines total $428 million, and potentially avoidable readmissions cost Medicare an estimated $17 billion a year. Last year, nearly 18 percent of Medicare patients who had been hospitalized were readmitted within a month. While that is lower than past years, roughly 2 million patients return a year, costing Medicare $26 billion. Officials estimate $17 billion of that comes from potentially avoidable readmissions.
The program has prompted some hospitals to beef up their discharge plans, enlisting care teams to follow up with patients after they go home to make sure they’re adhering to their medications. Medicare added two new categories of patients to consider this year: elective knee or hip replacements and lung ailments, including chronic bronchitis. Other categories are heart failure, heart attack and pneumonia.
To look at the data sources that were reviewed to compile this article and hospitals nationwide that were fined by CMS, click here Data Sources:
http://capsules.kaiserhealthnews.org/wp-content/uploads/2014/10/Readmissions-Year-3.pdf
http://www.oregon.gov/oha/OHPR/RSCH/Pages/databank.aspx
Diane can be reached at [email protected]
Jen can be reached at [email protected]
