The government is docking more than 2,200 hospitals, including several in central Ohio, up to 1 percent of their Medicare money in the next year because too many patients end up back in a hospital weeks after discharge.
The penalties are part of a plan to encourage hospitals to work harder to lower readmissions through efforts that include better patient education and closer monitoring of the follow-up care patients get once they're released.
Annually, about 2 million Medicare beneficiaries -- 1 in 5 -- are readmitted within a month of release at a cost of $17.5 billion. The national average readmission rate has stayed just above 19 percent for several years.
The payment cut at Ohio State University's Wexner Medical Center is the highest in Columbus, at 0.64 percent, which amounts to about $700,000, or less than a tenth of 1 percent of the hospital's revenue, said chief financial officer Michael Rutherford.
The rest of the penalties in Columbus are as follows: Grant Medical Center, 0.31 percent; Mount Carmel East and West hospitals, 0.29 percent; Riverside Methodist Hospital, 0.14 percent; Mount Carmel St. Ann's hospital, 0.13 percent; Doctors Hospital, 0.11 percent; and Dublin Methodist Hospital, 0.06 percent.
The reasons for readmissions are many and complex, said Dr. Blair Vermilion, the medical director of utilization management at Ohio State. They're further complicated by the fact that a person who is released from a major medical center such as Ohio State might then be readmitted to a smaller center closer to home, something that is out of the original hospital's control.
Ohio State doesn't have data to support it, but leadership thinks that the higher penalty likely reflects a more-challenging patient population, including transplant patients and a large volume of trauma patients, Vermilion said.
He applauded the government effort to improve patients' transitions home or into another care setting and said Ohio State is striving to improve that in a variety of ways, including initiating more contact with patients after they leave.
"This is a real important initiative, and we're really happy to participate. I think overall it's going to allow us to give a higher quality of care more efficiently and more effectively, and I think actually we're all excited to do that," Vermilion said.
Dr. Amy Imm, vice president of quality for OhioHealth, agreed.
The hospitals in the system have driven down readmission rates in recent years, and they continue to work on it, she said. "We believe there is ample opportunity for improvement."
OhioHealth did not provide an estimate of how much money it will lose in the next year.
The Mount Carmel Health System stands to lose about $400,000, said Gayle O'Brien, vice president of quality and safety.
She said the system, like others, is looking for innovative ways to keep patients well and out of the hospital after they leave.
"We're really focusing on clear communications, medication lists, do they understand instructions," she said.
The system is working to make sure that follow-up appointments with specialists or primary-care providers are on the books before patients leave the hospital, to help ensure they'll be seen soon after release, O'Brien said.
Aside from individual initiatives, hospitals have been working together through the Ohio Hospital Association to improve care and keep patients well once they leave the hospital, said John Palmer, the spokesman for the hospital group.
Nationally, Medicare is penalizing about two-thirds of the hospitals whose readmission rates it evaluated. The penalties fall heaviest on hospitals in New Jersey, New York, the District of Columbia, Arkansas, Kentucky, Mississippi, Illinois and Massachusetts, according to an analysis by Kaiser Health News. Hospitals that treat the most low-income patients will be hit particularly hard.
Across the country, 278 hospitals will lose the 1 percent maximum of their base Medicare reimbursements.
The maximum penalty will increase after this year to 2 percent of regular payments starting in October 2013 and then to 3 percent the following year.
Kaiser Health News and Dispatch reporter Ben Sutherly contributed to this story.