More than 100 SoCal hospitals hit with readmission penalties

Medicare is penalizing more than 100 hospitals in the five-county greater Los Angeles area  for having too many patients readmitted to their facilities within a 30-day period. 

A total of 111 hospitals in L.A., Orange, Riverside, San Bernardino and Ventura Counties got fined under the program – three out of four in the region. 

Southern California hospitals' penalties were slightly lower than last year's, and "about half those of the national average," says Jordan Rau, a senior correspondent with Kaiser Health News, who specializes in interpreting the annual Medicare data.

The penalties are based on the number of Medicare patients who are hospitalized for one of five conditions -  including heart attacks and elective hip and knee replacements – and then are forced to return for more care within a month of discharge.

When the number of these readmissions exceeds Medicare’s limit set for each hospital, the government reduces the amount of total Medicare dollars the facility gets in the next fiscal year, which for the federal government, begins each October.

Penalties by county

The fines are one way the Affordable Care Act tries to encourage hospitals to improve patient care, "to focus hospitals on actually paying attention to what happens to their patients after they leave," says Rau. "In the past the hospital didn’t have any reason to do that, financially."

While some hospitals nationwide got hit with the maximum penalty of 3 percent of their Medicare budget, the highest fine levied locally was 1.34 percent against UCLA Medical Center in Santa Monica.  When asked to comment on the penalty and how much it would cost, UCLA said no one was available to speak about the matter. 

The other hospitals receiving the highest penalty in each county were: Hemet Valley Medical Center in Hemet, 1.2 percent; Orange Coast Memorial Medical Center in Fountain Valley, .9 percent; St. Mary Medical Center in Apple Valley, .8 percent; and St. John's Regional Medical Center in Oxnard, .5 percent.

Many hospitals consider the penalties to be unfair. 

"The current methodologies that are used don’t recognize factors that are outside the hospital’s control," says Marty Gallegos, who specializes in health care policy for the Southern California Hospital Association.

For instance, he says, some people may not be able to afford medications they’re supposed to take, which can land them back in the hospital. And in an area, such as Los Angeles, people may have to ride several buses to get to a post-op appointment – making them more likely to miss it and to end up back in the hospital.

Another concern is that a hospital's performance is measured against the national average, says Rau.

"So you’ve got these hospitals hustling and they have lowered their readmission rates but if they’re still behind the nation’s average hospital they’re still going to get penalized," he says. 

The readmission penalties are not the only fines hospitals could face this year. Those with high rates of infection and other avoidable problems will be penalized as well. What’s more, Medicare is poised to impose fines based on an additional series of yet-to-be-announced quality measures.  But there’s also a carrot:  The government is planning to award bonuses to hospitals that meet those new quality measures.

All California hospitals and their readmission penalties: