Do Medicare Readmission Penalties Unfairly Target Safety-Net Hospitals?

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Are safety-net hospitals unfairly burdened by the new Medicare penalties on facilities with higher relative readmission rates?

Reading between the lines of a recent report by the California HealthCare Foundation’s Center for Health Reporting that appears to be the conclusion. The article–”Medicare penalizes hospitals with high readmissions”–is not not an indictment of Medicare’s new standards for readmissions, but it makes a convincing case that safety-net hospitals may be unfairly victimized by the program.

“Several of the hospitals paying big penalties this year are scattered up and down the sprawling Central Valley, from Tulare to Oroville, a region known for chronic health problems such as obesity and diabetes,” writes the Center’s Deborah Schoch. “Others serve under-privileged Los Angeles area neighborhoods that also have health challenges and lack the medical networks of wealthier communities.”

Tom Petersen, executive director of the Association of California Healthcare Districts, which represents smaller hospitals, believes the Medicare readmission penalty is discriminatory. The patient population his organization’s members serve are often low income and are less likely to have the resources to follow doctor’s orders for diet and medication once outside the hospital. “The hospital doesn’t have the ability to control behavior outside the hospital,” he said.

“But we think the current construction of the program is unfair,” says Nancy E. Foster, vice president for quality and patient safety policy at the American Hospital Association.  “It puts hospitals serving low-income patients at risk.  We don’t think that’s right.”

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Posted in Denials Management, Medical Receivables, Patient Experience, Patient Financial Services .

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