Beaufort Memorial loses a portion of Medicare funding

Hospitals and healthcare groups across South Carolina are working together to curb readmissions of Medicare patients within 30 days, after three-quarters of the state’s hospitals lost a small percentage of their reimbursement funds in penalties announced last month.

Statewide, nearly 50 hospitals lost a portion of their Medicare reimbursement money — on average, about .57 percent of their yearly reimbursement funds, according to data analyzed by Kaiser Health News, a non-profit national health policy news service.

Of those 50, Beaufort Memorial Hospital was the only one to lose the maximum amount for the 2016 fiscal year, a 3 percent cut of its reimbursement funds. Beaufort Memorial also received a 3 percent funding cut in the 2015 fiscal year, according to the Kaiser Health data.

Hospitals are penalized based on readmittance rates for Medicare patients within 30 days of their discharge, based on five different conditions measured from 2011 through early 2014, according to Beaufort Memorial Hospital chief financial officer Jeff White.

Both Coastal Carolina Hospital and Hilton Head Hospital also received Medicare penalties in the 2016 fiscal year closer to the state average: .60 percent for Coastal Carolina Hospital and .74 percent for Hilton Head Hospital, according to the Kaiser Health data.

The 3 percent cut for Beaufort Memorial only amounts to about $600,000, one-tenth a percent of the $600 million in gross patient revenue the hospital collects yearly, but it is still important, White said Wednesday.

“Anything that we don’t get in reimbursement is significant,” White said.

The penalties are doled out based on the readmittance percentages for five conditions: acute myocardial infarction, or heart attack; chronic obstructive pulmonary disease; heart failure; pneumonia; and hip and knee replacement.

White said the readmittance rates don’t take into account why the patient was readmitted, so in many of their cases it was for a unrelated condition. Of their 46 readmissions for hip and knee replacement patients, 31 of the readmittances had nothing to do with the surgical procedure, White said.

In one instance, a joint replacement patient was readmitted within 30 days for a car accident, and in another a patient was readmitted for a gunshot wound--both situations that counted against the hospital, he said.

White said the conditions monitored by the Centers for Medicare and Medicaid Services are also prone to overlap, leading to some instances where a patient is counted twice.

Both COPD patients may be admitted for pneumonia and heart attack patients for heart failure if the patients don’t continue to receive regular treatment and medicine, problems medical professionals are tackling locally and statewide.

Reached Friday, representatives from Coastal Carolina Hospital and Hilton Head Hospital did not provide requested data on discharge and readmission rates or what their Medicare penalty amounted to.

A state group called Preventing Avoidable Readmissions Together has been searching for solutions to the readmittance problem since 2012. A collective of representatives from hospitals and healthcare agencies across the spectrum, the group has found that the majority of avoidable Medicare readmissions occur because of a lack of resources for the patient once they are released from the hospital, PART program coordinator Laura Cole said Thursday.

Cole said PART has worked to improve communication between the patient, the hospital, and other health services that may assist in the person’s care after discharge, but has also worked to improve communication

PART’s focus, much like Beaufort Memorial Hospital’s focus locally, is on the quality of care after the person is released from the hospital. The group has simplified discharge instructions to make them easy to read for patients and encouraged hospitals and other healthcare organizations to ensure the patient has a support system at home to continue their recovery.

Cole said more healthcare agencies are working to ensure their patients have proper transportation options to make follow-up appointments and fill medication prescriptions.

Many patients in rural areas don’t even have basic amenities like food or electricity to go home to, so the organizations are working to make sure those basic needs are met, said Lorri Gibbons, vice president of quality improvement and patient safety with the S.C. Hospital Association.

Those improvements start on a local level, one PART is trying to encourage by contacting churches and support organizations, Gibbons said.

“They could have the best care in the world at a hospital and be ready to go when they’re discharged, but in two or three days they could return because they couldn’t get medicine or a ride to the doctor’s office,” Gibbons said. “Patient care goes beyond the walls of the hospital.”

Cole said the group’s initial findings and early results were published in healthcare journal Population Health Management’s August issue. Through early 2014, the same data used in Medicare’s reimbursement penalties, about 5,000 readmissions were prevented, Cole said.

Beaufort Memorial Hospital has continued to develop their Bridge to Home program, the hospital’s transitional-care department that helps patients set up their specific care needs after they are discharged. White said many of their readmitted patients don’t receive the care or the medicine they need after their release from the hospital and end up back in the emergency room.

With the new program in place, White said Beaufort Memorial has been able to reduce their readmission numbers, but like PART, it is still a work in progress.

“We’re doing anything we can to possibly help patients, to ensure their proper level of care and keep them at home with their families,” he said.

A joint statement from Hilton Head and Coastal Carolina hospitals said they, too, were working on preventing readmissions, but did not include what measures the hospital were taking to combat them.

“Hilton Head Hospital and Coastal Carolina Hospital are focused on better engaging patients and their loved ones during hospitalization, the discharge process and throughout the patient’s follow-up care,” the statement said. “We are committed to reducing preventable readmissions and improving the health and wellbeing of our communities.”

This story was originally published September 6, 2015 at 6:31 PM with the headline "Beaufort Memorial loses a portion of Medicare funding."