51 Out Of 66 Wisconsin Hospitals Penalized For Readmissions

Across the country, more than half the nation’s hospitals will pay penalties for having patients come back for care shortly after being released. In Wisconsin, the percentage of patients readmitted within a month is even higher.

Fifty-one out of 66 Wisconsin hospitals, or 77 percent, had more readmissions than allowed through the federal Hospital Readmissions Reduction Program. The penalties, in the form of Medicare reimbursement cuts, range from 0.02 percent to 2.93 percent, but Kelly Court, chief quality officer with the Wisconsin Hospital Association, says most of the penalties are small.

“While around 50 hospitals are getting the penalty, most of those penalties are quite small,” Court said. “Thirty-five of those hospitals are getting less than half a percent. The penalties max out at 3 percent.”

Medicare’s program to prevent readmissions started as part of Affordable Care Act. It doesn’t involve all hospitals or all patients, just Medicare patients with six conditions: heart attack, pneumonia, congestive heart failure, joint replacement, cardiac bypass surgery and chronic obstructive pulmonary disease.

Hospitals treating veterans, children and psychiatric patients are exempt from the federal Hospital Readmissions Reduction Program. Critical access hospitals are also excluded.

Wisconsin’s percentage of readmissions is higher than the national average, but lower than some other states. According to information compiled by Kaiser Health News, 90 percent or more of hospitals in Arizona, Connecticut, Florida, Kentucky, Massachusetts, Minnesota, New Jersey, New York and Virginia will receive lower Medicare reimbursement.

The size of Wisconsin’s penalties are relatively low in comparison to other states, Court said.

“When we look at that Wisconsin is the 12th best state in the country for the size of the penalty. So what that shows us is that while some of the hospitals do have excess readmissions, in relationship to hospitals across the country that excess readmission rate is fairly small,” Court said.

Nancy Foster, vice president for quality at the American Hospital Association, told Kaiser Health News that hospitals can’t prevent every readmission from happening.

“We have indeed reached the limits of what changes in how we deliver care will allow us to do,” Foster said. “We can’t prevent every readmission. It could be that there is further room for improvement, but we just don’t know what the technique is to make that happen.”

The readmissions data was collected on Medicare patients discharged between 2013 and 2016. The government looks at three years of data, so two of those years were also reviewed in assessing the previous year’s penalties.