Georgia Hospitals Penalized By Medicare

Georgia Hospitals Penalized By Medicare:

The Hospital Readmissions Reduction Program was enforced this week in Georgia when nearly 25% of all hospitals were penalized for unacceptable rates of patient injuries after discharge. Created by the Affordable Care Act to reduce hospital readmissions, the result is about a 1% loss of each hospital’s Medicare payments (this is based on previous penalties which resulted in a Medicare payment reduction of roughly 0.6%/patient stay, but hospitals could receive a maximum reduction of 3%). Designed to decrease the costs of patient readmissions and give hospitals “incentive” to pay attention to patients following discharge, this will effect 31 out of the 134 hospitals in Georgia (bringing the total number of hospitals penalized to a staggering total of 2,623). It is important to note that so far over half of all hospitals in the USA have been penalized, but the majority of those that have avoided penalties were not based on good patient readmission numbers, but because they were exempt from being evaluated! If a hospital meets certain criteria such as being designated a critical access facility or specializes in kids and/or veterans then they are not evaluated or subject to being penalized. Additionally are the hospitals that actually dealt with too few patients for what Medicare considered “accurate assessment” numbers.

Although it was actually a total of 31 Georgia hospitals (out of a total of 134 in the entire state) that were noted as having an excessive number of complications and patient injuries, only 13 received a penalty regarding Medicare. The hospitals that were penalized over the last three years by Medicare were:
– Memorial University Medical Center (located in Savannah)
– Tift Regional (located in Tifton)
– Candler Hospital (located in Savannah)
– AU Medical Center (located in Augusta)
– Southern Regional Medical Center (located in Riverdale)
– WellStar Atlanta Medical Center (located in Atlanta)
– WellStar Kennestone (located in Marietta)
– Piedmont Hospital (located in Atlanta)
– Piedmont Athens Regional (located in Athens)
– Crisp Regional (located in Cordele)
– Emory University Hospital (located in Atlanta)
– Grady Memorial (located in Atlanta)
– Meadows Regional in (located in Vidalia)
These hospitals will each lose 1% of their entire payments received from Medicare for one year (starting from October 2016). It is important to note that the reason was stated as an extremely high level of patient complications that included blood clots, serious infections, bed-sores and accidents such as falling.

The downside to this according to Kaiser Health News is the fact that the penalties also will reduce the amount of funding that each hospital receives for teaching medical residents and for providing low income care to patients. Additionally, some of these hospitals could potentially be financially impacted and hurt if more patients become aware of this situation and safety data. Patients could start to avoid hospitals that have been punished for low performance.

Whether you are for or against the Affordable Care Act, the fact of the matter is that it is currently the law and being enforced. What many find objectionable (obviously including all of the hospitals involved) is the fact that the Affordable Care Act actually mandates that Medicare penalize 25 percent of all hospitals. Many hospitals involved point out that they have made great strides in relation to improving patient safety, but that the Act forces them to be penalized anyway. Although everyone agrees that “hospital acquired conditions” have been reduced since 2010 (the year the Affordable Care Act was passed), the federal AHRQ (Agency for Healthcare Research and Quality) estimates that there were still 3.8 million hospital injuries last year. That translates to 115 injuries during every 1,000 patient hospital stays during that period.

As always, HCC is here to help you in any way that we can. Contact us online or call us today at 800-642-1652 to discuss how we can help you (or just if you’d like to talk about any idea that you may have regarding Pharmacy!). Healthcare Consultants is a nationally renowned full service Pharmacy staffing and consulting firm that has been in business for over 27 years. Owned, managed and staffed by full-time in-house Pharmacists, HCC offers a full range of Pharmacy Staffing & Placement, plus is noted for our Pharmacy Consulting Services that other firms simply cannot offer.


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