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11 Maine Hospitals Penalized Under ACA Program

Eleven Maine hospitals will be penalized by the federal government this year for having too many Medicare patients readmitted within a month.

It's the fourth year of the Hospital Readmissions Reduction Program, which began under the Affordable Care Act as a way to improve quality care. The penalties assessed to some Maine hospitals are going down, while others are going up.

Medicare tracks hospital readmissions for six conditions: heart attacks, heart failure, pneumonia, chronic obstructive pulmonary disease and elective hip and knee replacements. If a Medicare patient gets treated at a hospital for any of these conditions and returns through the hospital's doors within a month, there's a penalty.

"Overall I think hospitals in Maine believe that this is a good program," says Jeff Austin with the Maine Hospital Association. "It's something that Medicare and other payers should be doing. They should look at the outcomes of care, not just what the service was."

Austin says Maine's hospitals perform well compared to the rest of the nation.

The maximum penalty a hospital can receive is a 3 percent reduction in reimbursement for every Medicare patient admitted for care. The national average penalty is .6 percent. In Maine, it's .4 percent.

Maine Coast Memorial Hospital in Ellsworth saw its penalty increase for the second year in a row to just above 2 percent. Spokeswoman Patricia Patterson King says there's more to that number than meets the eye.

"Because our readmission rate has continued to go down," she says. "But it is the third year of the program, so the penalty rate increased."

The program gradually ups the ante on hospital readmissions and assesses penalties based on a three year rolling set of data. King says it will likely take another year before the numbers reflect quality improvements the hospital has implemented, which range from weekend primary care clinic hours to a new team that's revamping the discharge process.

"Specifically dealing with discharge instructions, ensuring the information patients have when they leave the hospital is clear and that they understand it," she says.

Patient education is something that Franklin Memorial Hospital in Farmington has put a lot of focus on in recent years. Vice President Gerald Cayer credits those efforts, along with patient "call-backs" with dropping the hospital's readmission penalty to zero this year.

"So once the individual is home, calling the patient to see how it's going, setting up any follow-up appointments that need to occur," he says.

These positive changes are why the Maine Hospital Association supports the readmissions penalty program.

But Austin says the program would be more effective if it also included a financial reward for hospitals that exceed expectations. He says hospitals can also be an easy target for the penalties, and some context should be taken into account.

"If a patient is discharged after receiving heart care and then spends four weeks in a nursing home and returns to the hospital with pneumonia, where is the fault of the hospital, such that it's going to receive a financial penalty?" he says.

Limitations to the program aside, Lisa Letourneau of the nonprofit Maine Quality Counts says readmissions are a big deal and deserve attention, no matter where your hospital of choice ranks.

"Even if your hospital is not on the penalty list, the average rate of hospital readmissions for Medicare patients is between 16 and 18 percent," she says. "That's still a lot of patients."

Letourneau advises all patients to ask a lot of questions, make sure they understand why they're in the hospital and find out how to take care of themselves when they return home.