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Feds crack down on Central New York hospitals to stop revolving door of ‘frequent flyer’ patients

Syracuse, N.Y. — Repeat customers, prized by most businesses, are becoming costly headaches for Central New York hospitals.

That’s because the federal government is now penalizing U.S. hospitals that have too many “frequent flyer” patients.

Hospitals with above-average rates of patients who come back within 30 days of their last hospital stay are seeing their federal Medicare payments reduced. The penalty will cost Central New York hospitals about $3.3 million over the next year, according to the Iroquois Healthcare Alliance, a hospital trade group.

Nearly every Central New York hospital is being penalized, with St. Joseph’s Hospital Health Center in Syracuse facing the biggest hit — an estimated $875,000.

The government says these readmissions are symptoms of wasteful spending and uncoordinated care in the U.S. health care system. The new penalties took effect Oct. 1.

Nearly one in five Medicare patients nationwide are readmitted to hospitals within 30 days of discharge, costing Medicare about $17.5 billion. The government says many of these repeat hospitalizations could be avoided if patients got better, more coordinated care in the hospital and after they are sent home.

Hospitals say some repeat stays cannot be prevented and they are being penalized in some instances for problems beyond their control.

Arthur Levin of the Center for Medical Consumers, a nonprofit consumer advocacy group in New York City, said some of the complaints coming from hospitals may be legitimate. But he believes the penalties will ultimately improve patient care.

“We can talk about reducing unnecessary admissions until we are blue in the face, but experience shows people start paying attention when there is money involved,” he said.

The penalties are required by the federal Affordable Care Act, also known as “Obamacare.” Hospitals with high readmission rates can lose up to 1 percent of their Medicare reimbursement. That maximum penalty will increase to 2 percent next October and 3 percent in 2014. The penalties will cost U.S. hospitals about $280 million over the next year.

The penalties are tied to excessive readmissions of heart attack, heart failure and pneumonia patients.

St. Joseph’s is the only hospital in the area hit with the maximum penalty of 1 percent. Two hospitals in the region — Cayuga Medical Center in Ithaca and Community Memorial in Hamilton — are not being penalized because they had lower than average readmission rates.

While the percentages appear small, they can cause significant financial pain for Central New York hospitals. That’s because Medicare patients typically account for 50 percent to 60 percent of a hospital’s business, said Gary Fitzgerald of the Iroquois Healthcare Alliance. Medicare is the government health insurance program that covers people 65 and older and the disabled.

New York hospitals operate on thin profit margins and many are losing money, Fitzgerald said. “This just adds to the burden,” he said.

St. Joseph’s operates a big cardiac program that attracts many patients with heart disease. That may be a factor influencing its readmission rates, said Mark Murphy, a senior vice president at the hospital. The hospital also sees many patients who do not have regular primary care doctors, he said. That can lead to repeat hospitalizations, because follow-up care with a primary care doctor is an important ingredient for recovery, he said.

Hospitals are being penalized for readmissions no matter why the patient comes back.

A patient, for example, could be hospitalized for a heart attack, go home, fall down and break a leg. If the patient goes back to the hospital within 30 days for the leg problem, Medicare views that as an unnecessary readmission, even though the patient’s return trip is unrelated to the heart attack.

Experts say some readmissions are unavoidable, because of the nature of chronic illnesses. A minor chest infection, for example, can make it difficult for a patient with lung disease to breathe, prompting a trip to the emergency room and hospital admission.

“Nobody’s disease comes from start to closure all at once,” said Dr. John McCabe, CEO of Upstate University Hospital. “With most diseases, especially diseases that kill people, you stumble along. You get sick, you get better and it’s not a straight line event.”

Cayuga Medical Center officials attribute their hospital’s lower than average readmission rates to close cooperation between the hospital and community physicians. Before a patient is discharged, hospital staffers make appointments for follow-up care with the patient’s primary-care doctor. The hospital also sends the doctor a detailed summary of everything that happened during the patient’s hospital stay.

“This is a way for us — the physicians and the hospital — to hold each other accountable for the care we are giving,” said Dr. Rob Mackenzie, Cayuga’s president and CEO.

Syracuse hospitals are doing similar things.

St. Joseph’s tries to set up primary care doctor appointments for patients within five days of discharge. It also has a pharmacist visit patients before discharge to eliminate any confusion about what drugs they must take when they get home.

Upstate tries to make sure discharged patients have transportation so they can get to follow-up visits with the primary-care doctors after discharge.

Hospitals also are sending nurses to check up on patients after go home. Crouse launched such a program in 2007 that focused on congestive heart failure patients, who have the highest rate of readmission nationwide. Crouse officials say it has seen a significant decrease in readmission rates among patients in that program. It has since expanded that program to patients with other illnesses such as chronic obstructive pulmonary disease.

Keeping people out of the hospital can be even harder sometimes in rural communities where there may not be enough home care and other services available to people going home.

That was an issue in Madison County, where the county-owned home-care agency was operating in the red for several years.

“We didn’t have a lot of home-care services,” said Jay Kohlbrenner, a vice president of Oneida Healthcare Center in Oneida.

Home Care of Rochester Inc. took over the Madison County agency earlier this year. Kohlbrenner said the increased availability of home care is helping Oneida reduce readmissions.

Patients and their families have an important role to play in preventing rehospitalization, said Derrick Suehs, chief quality officer for Crouse Hospital.

“Health care is a ‘we’ thing,” Suehs said. “Not me receiving something from a doctor. Not me receiving something from a hospital. We own this all together.”

Patients, especially if they are elderly, need a relative or friend to serve as an advocate and ask questions so they understand what the patient needs to do after leaving the hospital, he said.

The readmission penalty is not the only tactic Medicare is using to encourage hospitals to improve. Later this year the health insurance program will begin financially rewarding or penalizing hospitals on other indicators that measure patient satisfaction and how closely hospitals follow basic standards of care.

“Money talks,” said Levin of the Center for Medical Consumers. “How do you drive the system to where you want it to go unless you set goals?”

Source: James T. Mulder, The Post Standard-Thursday, October 11, 2012,  6:00 AM at

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