Nearly all of the qualifying hospitals in New Hampshire face sanctions by Medicare for readmitting too many patients within 30 days of their discharge.
Twelve of the 13 hospitals evaluated in the state, including Concord Hospital, will not be fully reimbursed by Medicare due to high readmission rates, according to recent data from the Centers for Medicare and Medicaid Services. Hospitals that offer services to veterans, psychiatric services, or that serve as one of the only points of care for patients in rural areas, were exempt from the review.
Every year, Medicare compares hospitals to their peers to determine if, and by how much, they should be penalized. Each hospital is placed into a group that corresponds with the proportion of low-income patients they care for. If a hospital’s readmission rate over three years is higher than that of the hospitals in their respective group, Medicare can cut their payments by up to 3% for each Medicare patient during the 2021 fiscal year, between October 2020 and September 2021.
On average, payments were cut by .69% for each penalized hospital. Several N.H hospitals came out with above-average fines, however. Concord Hospital received a penalty of 1.2%, only lower than one other hospital in the state, Parkland Medical Center in Derry. Only about 600 other hospitals in the country received a penalty greater than 1%. More than half of the hospitals in the country were penalized this fiscal year.
Jennifer Dearborn, a spokesperson for Concord Hospital, said the hospital is expecting to lose hundreds of thousands of dollars from the reimbursement cut.
“Given we are still in the midst of responding to COVID-19 challenges, this reduction in revenue is significant,” she said.
The Hospital Readmissions Reduction Program program was developed in 2012 to incentivize hospitals to reduce avoidable readmissions for patients with six specific conditions including pneumonia and heart failure. The hope was that threats of fines would motivate doctors to perform nonclinical work that has been shown to reduce readmissions, like making follow-up calls and reminding patients to take their medication.
However, critics of the program have said this program unfairly targets hospitals that treat patients who are at high risk of readmission like low-income or older individuals. Lauren Collins-Cline, a spokesperson for Catholic Medical Center, said the hospital’s high rates are a reflection of Manchester’s population, which treats some of the highest acuity patients in the state.
“All of the community hospitals in New Hampshire are impacted by readmission penalties,” she said. “This is unfortunate, but not entirely unexpected, given the impact of chronic health conditions in New Hampshire, especially heart failure and diabetes, as well as our aging population.”
Five hospitals in the state, including Catholic Medical Center and Southern NH Medical Center, were hit with a 1% reimbursement cut for high numbers of infections and patient injuries. Medicare doles these punishments out to hospitals with the highest rates of infection, blood clots, sepsis, and other complications.
Collins-Cline said caring for the vulnerable patients in Manchester also contributes to hospital-acquired infections at CMC but nonetheless, they are working to improve both their readmissions and HAI statistics.
These fines come at a rough time for the state’s hospitals, which have lost hundreds of millions of dollars in revenue since the start of the pandemic. Many facilities have had to make sacrifices. In April, CMC furloughed hundreds of staff members, and in August, they laid off 71 employees. They also reduced hours for 40 positions and froze hiring for all nonessential positions.
The CMS said it would consider pausing the program in the future if the pandemic makes it too difficult to assess hospital performance. However, for the time being, hospitals are bracing for yet another hit to their finances.