Please see attachments below for week #5 reading assignment, REQUIRED article & assignment instructions. Please follow assignment instructions. The paper will be due on Sunday, February 3rd, 2019 by 11:59pm. Thank you..
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Half Of Nation’s Hospitals Fail Again
To Escape Medicare’s Readmission
Penalties
By Jordan RauAUGUST 3, 2015
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Once again, the majority of the nation’s hospitals are being penalized by Medicare for
having patients frequently return within a month of discharge — this time losing a
combined $420 million, government records show.
In the fourth year of federal readmission penalties, 2,592 hospitals will receive lower
payments for every Medicare patient that stays in the hospital — readmitted or not —
starting in October. The Hospital Readmissions Reduction Program, created by the
Affordable Care Act, was designed to make hospitals pay closer attention to what
happens to their patients after they get discharged.
Illustration by Andrew Villegas/istockphoto
Since the fines began, national readmission rates have dropped, but roughly one of
every five Medicare patients sent to the hospital ends up returning within a month.
Some hospitals view the punishments as unfair because they can lose money even if they
had fewer readmissions than they did in previous years. All but 209 of the hospitals
penalized in this round were also punished last year, a Kaiser Health News analysis of
the records found.
GET THE DATA
MEDICARE HOSPITAL PENALTIES YEARS 1 TO 4
Medicare is penalizing hospitals that see patients return to the hospital too soon after
being discharged. Medicare reduces what it pays each hospital per patient, per stay.




Medicare Readmission Penalties By Hospital
(.csv)
Medicare Readmission Penalties By Hospital
(.pdf)
Medicare Readmission Penalties By State (.csv)
Medicare Readmission Penalties By State (.pdf)
The fines are based on readmissions between July 2011 and June 2014 and include
Medicare patients who were originally hospitalized for one of five conditions: heart
attack, heart failure, pneumonia, chronic lung problems or elective hip or knee
replacements. For each hospital, Medicare determined what it thought the appropriate
number of readmissions should be based on the mix of patients and how the hospital
industry performed overall. If the number of readmissions was above that projection,
Medicare fined the hospital.
The fines will be applied to Medicare payments when the federal fiscal year begins in
October. In this round, the average Medicare payment reduction is 0.61 percent per
patient stay, but 38 hospitals will receive the maximum cut of 3 percent, the KHN
analysis shows. A total of 506 hospitals, including those facing the maximum penalty,
will lose 1 percent of their Medicare payments or more.
Overall, Medicare’s punishments are slightly less severe than they were last year, both in
the amount of the average fine and the number of hospitals penalized. Still, they will be
assessed on hospitals in every state except Maryland, which is exempt from these
penalties because it has a special payment arrangement with Medicare.
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This KHN story can be republished for free (details).
These lower payments will affect three-quarters of hospitals or more in Alabama,
Connecticut, Florida, Massachusetts, New Jersey, New York, Rhode Island, South
Carolina, Virginia and the District of Columbia. KHN found that fewer than a quarter of
hospitals face punishments in Idaho, Iowa, Kansas, Montana, Nebraska, North Dakota
and South Dakota.
REPUBLICATION NOTE
The readmission data in this story and charts is assembled, interpreted and analyzed by
KHN using five files from the federal Centers for Medicare & Medicaid Services. KHN’s
data is free to republish and should be credited to Kaiser Health News or Kaiser Health
News and the U.S. Centers for Medicare & Medicaid Services. KHN’s republishing rules
can be found here.
Most of the 2,232 hospitals spared penalties this year were excused not because
Medicare found readmissions to be sufficiently infrequent, but because they were
automatically exempted from being evaluated — either because they specialized in
certain types of patients, such as veterans or children, because they were specially
designated “critical access” hospitals, or because they had too few cases for Medicare to
accurately assess.
The readmission penalties are not the only fines hospitals face this year. As it did last
year, Medicare is also giving out bonuses and penalties based on a variety of quality
measures. The government has not yet announced those, but they also begin in October.
Those financial incentives will total about $1.5 billon. Medicare will also punish
hospitals with high rates of infections and other avoidable occurrences of patient harm.
The KHN analysis found that four hospitals have received the maximum readmission
penalty every year. Two are in Kentucky: Harlan ARH Hospital, which is in the heart of
the Appalachian coalfields, and Monroe County Medical Center in Tompkinsville. The
other hospitals are the Livingston, Tenn., Regional Hospital — also in Appalachia — and
Franklin Medical Center in Winnsboro, La. None of the hospitals immediately returned
phone calls Monday.
Hospitals have been lobbying both Medicare and Congress to take into account the
socio-economic background of patients when assessing readmission penalties. They
argue that some factors for readmissions — such as whether patients can afford
medications or healthy food — are beyond their control.
The Medicare Payment Advisory Commission, which advises Congress, has
recommended altering the readmission penalties. The National Quality Forum, a
nonprofit that Medicare looks to when creating quality metrics, is examining whether
socio-economic factors should be included when calculating readmission measurements
as well as other barometers of hospital quality. But that experiment will take two years
to complete.
“Hospitals should not be penalized simply because of the demographic characteristics of
their patients,” Sens. Joseph Manchin III (D-W.Va.) and Roger Wicker (R-Miss.) wrote
last week in the Journal of the American Medical Association. The senators
have introduced a bill to consider socio-economic factors when calculating the penalties.
Their essay, co-written by Dr. Andrew Boozary, a health policy analyst, pointed to a
study that found safety-net hospitals were nearly 60 percent more likely than other
hospitals to have been penalized in all of the first three years of the penalties. Hospitals
with the lowest profit margins were 36 percent more likely to be penalized than those in
better financial shape, the essay said.
In regulations released Friday, the Centers for Medicare & Medicaid Services reiterated
that it would not unilaterally make such changes in the program, noting that some
safety-net hospitals have been able to keep their readmission rates low.
“While we appreciate these comments and the importance of the role that
sociodemographic status plays in the care of patients,” the agency wrote in the rule, “we
continue to have concerns about holding hospitals to different standards for the
outcomes of their patients of low sociodemographic status because we do not want to
mask potential disparities or minimize incentives to improve the outcomes of
disadvantaged populations.”
KHN’s coverage of aging and long term care issues is supported in part by a grant
from The SCAN Foundation.
Medicare Readmission Penalties By State, Year 4
Medicare evaluated the readmission rates of the nation’s hospitals in determining the fourth year of penalties in the
Hospital Readmissions Reduction Program. Medicare will apply the penalties to all its payments for patient stays
between Oct. 1, 2015, and Sept. 30, 2016. In this chart, the first column after the state name shows the total number
of hospitals penalized in each state. That is followed by the percent of each state’s hospitals that were penalized.
That calculation includes hospitals exempted from the fines, such as those serving veterans and children. The final
column shows the average penalty for penalized hospitals. *The penalties do not apply to Maryland hospitals, as that
state has a unique reimbursement arrangement with Medicare, and thus Maryland is not included in this table.
State Name
Alabama
Number of
Penalized
Hospitals
Percent of All
Hospitals
Penalized
Average
Hospital Penalty
(Percent)
72
79
0.61
Alaska
7
33
0.44
Arizona
49
62
0.48
Arkansas
41
53
0.83
California
224
65
0.4
Colorado
25
32
0.29
State Name
Connecticut
Number of
Penalized
Hospitals
Percent of All
Hospitals
Penalized
Average
Hospital Penalty
(Percent)
28
90
0.66
Delaware
5
71
0.35
District of Columbia
7
78
0.77
Florida
154
81
0.67
Georgia
89
67
0.47
Hawaii
10
56
0.33
4
10
0.58
Illinois
113
62
0.72
Indiana
64
51
0.59
Iowa
25
21
0.62
Kansas
32
24
0.44
Kentucky
62
65
1.19
Louisiana
66
55
0.68
Maine
11
31
0.4
Massachusetts
51
78
0.70
Michigan
69
50
0.64
Minnesota
39
30
0.37
Mississippi
54
55
0.61
Missouri
67
61
0.71
Montana
5
9
0.70
2,592
54
0.61
14
15
0.39
Idaho
NATIONAL
Nebraska
State Name
Number of
Penalized
Hospitals
Percent of All
Hospitals
Penalized
Average
Hospital Penalty
(Percent)
Nevada
20
56
0.57
New Hampshire
11
42
0.45
New Jersey
63
97
0.73
New Mexico
18
43
0.37
140
77
0.75
North Carolina
76
68
0.56
North Dakota
3
7
0.14
109
64
0.71
Oklahoma
63
50
0.55
Oregon
21
34
0.32
Pennsylvania
128
74
0.61
Rhode Island
9
75
0.63
South Carolina
47
75
0.57
South Dakota
8
15
0.66
78
70
0.64
Texas
203
54
0.53
Utah
16
35
0.53
Vermont
4
27
0.08
Virginia
68
80
1.01
Washington
36
39
0.37
West Virginia
27
52
0.99
Wisconsin
49
39
0.38
New York
Ohio
Tennessee
State Name
Wyoming
Number of
Penalized
Hospitals
Percent of All
Hospitals
Penalized
8
Average
Hospital Penalty
(Percent)
29
Source: Kaiser Health News analysis of data from the Centers for Medicare & Medicaid Services Get the data
0.37

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