The penalties will be as much as 2 percent of Medicare reimbursements, and could be worth millions of dollars to large nursing-home chains with locations spread across Indiana and the nation.
Indiana Business Journal
It’s the latest crackdown on health-care providers — and it could be costly for many.
Two-thirds of Indiana’s 544 nursing homes will get lighter reimbursement checks from the federal government for the next year, for having too many patients re-admitted to hospitals within a month of discharge.
The penalties will amount to as much as 2 percent of Medicare reimbursements, and could be worth millions of dollars to large nursing-home chains with dozens of locations spread across Indiana and the nation.
The government says hospital re-admissions are often unnecessary and cost taxpayers more than $4 billion a year.
The Centers for Medicare and Medicaid Services published a massive list this month outlining which nursing homes will be affected, and by how much. It followed nearly four years of discussion on how to reward and penalize nursing homes based on their hospital re-admission rates.
Across Indiana, 359 nursing homes are getting penalized for high re-admission statistics. A smaller number, 174, will get bonuses for keeping re-admissions low. Eleven nursing homes will see no change.
The list did not say how many re-admissions each nursing home had, or what the dollar penalty would be. Nationally, nearly 72 percent of the more than 15,000 nursing homes will be penalized.
The penalties come on top of other financial setbacks, including a shorter number of days that Medicare will pay for most patients staying in skilled-nursing facilities after a hospital discharge. Over the past five years or so, the length of stay has dropped from 30-45 days to 15-25 days, said Zachary Cattell, president of the Indiana Health Care Association, the state’s largest trade association for assisted-living and long-term care.
“If you cobble these payment crunches with the shorter number of days that people are staying, it is adding a significant amount of financial stress for providers,” he said.
In the Indianapolis area, 13 nursing homes are tied for the highest penalty of about 2 percent, but hundreds of others will face varying degrees of reimbursement cuts.
Some large nursing-home chains — such as American Senior Communities, which operates 87 locations — have been trying to reduce hospital re-admissions by expanding patient education and post-discharge follow-ups. ASC also has been collaborating with hospitals to monitor patients and provide the best nursing care possible after hospital discharge.
The company did not say how many of its facilities will be penalized, or what the likely financial impact would be. The government did not identify individual nursing homes by owner, so it is difficult to say which companies will be affected to what degree.
Some patient advocacy groups say they support the government’s penalties and rewards. Some say nursing homes are frequently understaffed, which leads to medical problems for patients, including pressure ulcers, falls and dehydration.
Those conditions, if left untreated, can result in a hospital re-admission, said Michelle Niemier, deputy director of the Center for At-Risk Elders, a not-for-profit, public-interest law firm in Indianapolis. “Adequate staffing is absolutely key to quality care,” she said.
The government said a great many re-admissions are preventable: More than 23 percent of skilled-nursing-facility stays resulted in a re-hospitalization within a month of the initial hospital discharge. The average Medicare payment for each readmission was $10,352, for a total of $4.34 billion, according to a widely followed study, Medicare said. Of those re-admissions, 78 percent were deemed “potentially avoidable.”
