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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2017 Pharmacy Focus, Challenges & Opportunities

Pharmacy Focus, Challenges and Opportunities in 2017:

A new year is here and Pharmacy issues, challenges and opportunities are more abundant and complex than ever before. New Pharmacy advancements and rapid changes in disease treatments, legislation, insurance issues, media attention and a more informed patient have certainly resulted in one significant fact: the roles that Pharmacists play as part of the Healthcare Team are both expanding and becoming more demanding on our skills. The result is that Pharmacists are being challenged now more than ever to be at the “center” regarding total patient care. A Pharmacist’s role is no longer focused only on their expertise regarding a patient’s medications, but as perhaps the central player in ensuring a patient’s well being. This means both increased involvement with all other Healthcare professionals, as well as increased communication with physicians, nurses, ancillary healthcare staff, caretakers, insurance companies and of course, the patient and the patient’s families.

The vitally important role that we at HCC see the Pharmacist playing now (and ever increasing in the future) is one of being both the “communicator” and the “educator”. One of the reasons this is taking place is that if you drew a diagram of all the healthcare roles and functions that are involved in ensuring great patient care, the Pharmacist is in many cases at the center. It is the Pharmacist who must ensure that there is always an accurate flow of information taking place between many of the healthcare team members, and then again it is the Pharmacist who often times is the one communicating directly with the patient and their family members. This not only relates to medications and making sure that factors such as accuracy of dosages, appropriate choice of medication for individual patients, correct administration instructions, checking for adverse drug interactions, adequate counseling and of course compliance all take place. The real focus has become education. After all, who is the real expert on drugs and medications? Once again the most recent Gallup poll shows that Pharmacists are at the top of the list for the most trusted professionals (see Gallup Poll). The public respects a Pharmacist’s knowledge, ethics, expertise and opinions. Add to this that studies have shown that patients are “more likely to be honest when talking to their Pharmacist versus their doctor”. This was related to the fact that most patients interacted with their community Pharmacist much more often than with their physicians or other healthcare providers on a “routine basis”. One example cited was a patient who had a total of 11 different physicians! Additionally, the point can be made that the specialization of physician care has led the public to view doctors as “only focusing on their piece of the overall picture” and leaves the Pharmacist as the “overseer” who manages the entire patient care. This can be especially true when settings such as clinics and large multi-staff physician practices are involved.

The point is that a Pharmacist’s role is no longer viewed as simply as being a “pill counter, placing a label on the bottle and then being a cashier”. As a profession we are now responsible for counseling patients and increased communication with an expanding number of other healthcare team members. This direction is a “must’ for each of us to undertake in order to ensure increased patient medication compliance and build the best healthcare aviabale. This means expanding our own skills and education to perform tasks that perhaps many of us never did before (Pharmacogenetic testing is a great example as discussed in one of our recent posts – Pharmacogenetic Testing in Community Pharmacies. Physicians, related healthcare practitioners, insurance providers and especially patients are demanding this of us. It is interesting to note that of the 10 “Top-Read Health-System Articles in 2016” on Pharmacy Times , over half were about patient and/or physician counseling and communication regarding specific diseases and the Pharmacists role as a “team member”.

2017 is an exciting time to be practicing Pharmacy! The opportunities for us as both individuals and as a profession are almost limitless. Plus they are increasing at a rate never seen before. It is our choice to each participate and play a major role in this “revolution” in US healthcare, or to “sit on the sidelines” as an observer. I hope we all choose wisely.

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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