L+M, Backus keeping patient readmission rates under control

October 12, 2018

Southeastern Connecticut’s hospitals are doing a relatively good job of keeping the Medicare patients they treat and release from having to be readmitted.

Both Lawrence + Memorial Hospital in New London and the William W. Backus Hospital in Norwich face penalties for readmission rates the Centers for Medicare & Medicaid Services deem too high, but their penalties are among the lowest assessed on Connecticut hospitals and are well below the national average.

“We’re fairly proud of our performance,” said Dr. Oliver Mayorga, chief medical officer for L+M Healthcare, which includes L+M and Westerly hospitals.

L+M will lose 0.19 percent of its Medicare reimbursement payments during the fiscal year that began Oct. 1, down from 0.27 percent the previous year. Backus’s penalty this year is 0.21 percent, unchanged from last year.

Hospitals are penalized for patients readmitted within a month of being discharged.

Overall, 27 of 29 hospitals in the state are being penalized this year, the Connecticut Health Investigative Team reported this week. C-HIT based its report on a Kaiser Health News analysis of federal data.

Nine Connecticut hospitals face Medicare reimbursement reductions of more than 1 percent, with Waterbury Hospital receiving the stiffest penalty, 2.19 percent. The maximum penalty is 3 percent.

“I would characterize Backus as good, with room for improvement,” said Dr. Rocco Orlando III, senior vice president and chief medical officer for Hartford HealthCare, of which Backus is a member. He noted that Backus fared better than the other hospitals in the Hartford HealthCare system.

“The goal is to get to zero and we’re actively pursuing that,” Orlando said. “But given the barriers and obstacles, Backus performed fairly well.”

Mayorga said the penalty rates are based on national averages and provide an indication of the overall care a hospital provides. Hospitals that take better care of their patients while they’re admitted are likely to have lower readmission rates. Improving discharged patients’ follow-up care drives rates lower.

“Making sure a patient is discharged with the right prescriptions, fully understands his or her diagnosis and has transportation to get to the pharmacy and to follow-up appointments is essential,” Mayorga said.

L+M benefits from its relationship with the Visiting Nurse Association of Southeastern Connecticut, whose nurses ensure that discharged patients have the care they need in their homes. In the case of homeless patients, the hospital teams with the New London Homeless Hospital Center, providing funding for six “respite” beds at the center.

“If we release patients who are homeless and we don’t acknowledge that, if we don’t ensure they have transportation to follow-up appointments or don’t have good food, they’ll be back,” Mayorga said.

Orlando said discharged patients who go to nursing facilities rather than to their own homes are more likely to be readmitted to the hospital.

“Forming quality-care partnerships with nursing homes is important,” he said. “If you’re going into a nursing home, it’s because you’re sicker (than a patient returning to home). There are things you can do, like having a nurse practitioner visit a patient in a nursing home.”

Given Connecticut’s aging population, it’s going to become more and more of a challenge to keep discharged patients in their homes, Orlando said.

“Nursing home care is very expensive,” he said.

The Medicare program has been penalizing hospitals for high readmission rates since 2012 in connection with the Affordable Care Act’s push to promote better health care. Kaiser Health News found that 2,599 hospitals — more than half in the nation — will be penalized this fiscal year, with the lost reimbursement payments totaling $566 million.

Backus’s penalty will be in the tens of thousands of dollars, a small amount given the size of the hospital’s overall budget, Orlando said.

“We’re motivated to do it (improve readmission rates) because it’s the right to do,” he said. “We don’t want patients bouncing back to the hospital.”


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