80% of NY hospitals face Medicare reimbursement penalties

Oct 13, 2014

Eighty percent of hospitals in New York state face penalties based on the number of Medicare patients that are readmitted into their care.

The federal government wants to reduce the number of avoidable hospital readmissions. This is the third year Medicare will cut reimbursements to hospitals based on the number of patients who have to check back in with complications from lung ailments, heart failure, heart attack, pneumonia, or after a hip or knee replacement.

Jordan Rau, senior reporter for Kaiser Health News, says New York currently ranks fifth in the nation for penalties.  He says the feds don’t want hospitals to profit off returning patients.

“The studies that have been done estimate that anywhere from one-third to two-thirds of readmissions are potentially avoidable. And I think that's what this is aiming to do. It's not to make readmissions never happen, but it's to reduce the numbers that could have been handled in a different setting, that might be less expensive and might be better for the patient,” explains Rau.

The national average penalty is 0.63 percent, but in New York the average penalty is close 0.73 percent. The maximum penalty is 3 percent.

On average penalties doubled across the nation over last year, but in New York they rose more slowly—up less than a quarter of one percent.

Many hospitals say there are many factors that cause patients to fare poorly after being sent home from a hospital stay—including poverty.

“Some of them can't afford medication. Some of them don't have a primary care doctor that they can go see. Often, if you've got something like heart failure and you have to adhere to a very strict non-salt diet, that's difficult for someone to do if you don't have $150 to dump at Wholefoods every week,” Rau said.