Most Southwest Florida hospitals are holding their own against potential Medicare cuts as a form of punishment if they have higher than expected readmission rates, according to new federal data.
No hospitals in Lee or Collier counties will face the full potential of a 1 percent base rate cut while several hospitals in Miami and Orlando are in that predicament, according to the U.S. Centers for Medicare and Medicaid Services.
Lehigh Regional Medical Center, an 88-bed hospital in eastern Lee operated by the Naples-based Health Management Associates, will face a 0.58 percent Medicare rate cut starting Oct. 1. That's the largest hit among the nine hospitals in the two counties.
Hospitals nationwide have been bracing for the penalties from the federal government for higher readmission rates among patients suffering from three conditions — heart failure, heart attack and pneumonia.
The measure was included in the 2010 Affordable Care Act to force hospitals to be more proactive to prevent readmissions within 30 days of a patient's discharge.
About 20 percent of Medicare patients who get discharged from a hospital are readmitted within 30 days and the tab is $17 billion, according to a 2009 New England Journal of Medicine study.
Historically, there's been no incentive for hospitals to prevent readmissions and today they are taking measures to better coordinate with home health agencies to make sure patients follow post-discharge plans.
The 349-bed Gulf Coast Medical Center in Fort Myers will see a 0.28 percent cut and the 415-bed Lee Memorial Hospital will face a 0.11 percent rate reduction, according to the Centers for Medicare and Medicaid Services. Both are public hospitals operated by the Lee Memorial Health System.
The only other local hospital in the region that will be penalized is the 101-bed Physicians Regional Medical Center-Pine Ridge in Collier with a 0.01 percent rate cut. Physicians Regional is owned by HMA.
Alan Levine, president of HMA's Florida hospitals, said the company's hospitals overall are doing well in improving quality. The readmission penalty is new territory for the hospital industry overall, he said.
"When we focused on improving core measures, we shot up," Levine said of HMA hospitals.
Sixty percent of HMA hospitals have made the best performing list released by the Joint Commission, the main accreditation agency of hospitals, he said.
The Medicare rate cut for hospitals that continue to have higher-than-expected readmissions rates goes to 2 percent next year and 3 percent in 2014.
Lee Memorial was initially expecting a 0.02 percent rate cut based on a Florida Hospital Association analysis, said Mary Briggs, Lee Memorial spokeswoman.
Based on the Centers for Medicare and Medicaid Services data, Lee Memorial expects to lose several hundred thousand from its Medicare reimbursement. All told, Medicare is about 51 percent of Lee Memorial's payer source; she didn't have a figure for what that is dollar-wise.
The Medicare rate cuts will happen even if a hospital is slightly off expectations, which is what happened for Lee Memorial, she said.
"All of our readmissions rates are no different than the national rate," Briggs said.
The hospital system has launched several programs to reduce readmissions by better post-discharge follow up, such as having a physician who makes house calls and by having a telephone monitoring program, she said.