Medicare levies higher average penalties on SoCal hospitals for high readmission rates

 Medicare is increasing its penalties against more than 100 hospitals in Southern California for having too many patients readmitted to their facilities within 30 days of discharge, according to federal data. 

The region's average penalty was just over one-half of 1 percent of total Medicare reimbursements; last year it was one-third of 1 percent. Still, that's lower than the national average, says Jordan Rau, a Kaiser Health News journalist who interpreted the annual Medicare data.

In Southern California, 109 hospitals – or nearly four out of five of those reviewed in Los Angeles Orange, Riverside, San Bernardino and Ventura Counties -  got fined after the annual federal review, he says.

The penalties, which take effect in October, are one of the ways the Affordable Care Act tries to get hospitals to improve patient care.

The average penalty may have increased this year because the federal government added a new measure for readmissions - heart bypass surgery. 

That brings to six the number of situations Medicare uses to measure rehospitalizations. The others are heart attacks, heart failure, pneumonia, chronic lung disease and hip and knee replacements.

SOUTHERN CALIFORNIA PENALTIES BY COUNTY

When the number of readmissions exceeds the national average, the government reduces – by up to 3 percent - the amount of total Medicare dollars the facility receives for the next fiscal year.

The program does not measure readmission rates at a variety of facilities, including veterans', children's and psychiatric hospitals.

The addition of the sixth measure may have influenced outcomes nationwide. The federal government will fine more than half of the nation’s hospitals a total of $528 million  – about $100 million more than last year, Rau says.

"The more conditions they look at for excess rate of admissions, the more likely a hospital is going to be fined and the more they will be fined," he says.  

Locally, the highest fine levied was against Glendale Adventist Medical Center, which will lose 2.5 percent of its Medicare payments for the year starting in October.

Glendale Adventist spokeswoman Alicia Gonzalez says the hospital added a full-time registered nurse to help reduce its readmission rates about six months ago, and has since seen "dramatic improvements in reducing those numbers."

The hospital industry opposes the use of financial penalties as a way to reduce readmissions.

The program fails to "take into consideration the 'social determinants' of care  - those factors that are outside of the hospital’s control - that often result in patients needing to be readmitted," Jan Emerson-Shea, spokeswoman for the California Hospital Association, said in an email to KPCC.

"As a result, hospitals that treat high volumes of low-income patients tend to have higher readmission rates and incur the maximum penalty under the program," she said.

ALL CALIFORNIA HOSPITALS AND THEIR READMISSION PENALTIES