UW, Meriter hospitals penalized for readmissions, St. Mary's not

Jan. 2—UW Hospital and Meriter Hospital are receiving small penalties from Medicare this year for having too many readmissions of discharged patients, while St. Mary's Hospital in Madison is not being penalized.

The federal program, which started in 2012 as part of the Affordable Care Act, cuts Medicare payments to hospitals by up to 3% if they have more readmissions than expected, based on the makeup of their patients.

For fiscal 2023, which started in October, UW Hospital is receiving 0.16% less from Medicare and Meriter is getting 0.07% less because of what are considered unnecessary readmissions. UW Hospital's penalties have been growing slightly since 2020, when its reduction was 0.09%. Meriter didn't have penalties the past two years, and St. Mary's hasn't had one since 2020.

In Wisconsin, 48 of 66 hospitals covered by the program were penalized this year, with an average cut of 0.38%. Nationwide, three-fourths of hospitals in the program were penalized, with an average reduction of 0.43%, according to Kaiser Health News, which made the data readily available.

The goal is to get hospitals to improve discharge planning and follow-up care for patients so they don't become sick enough to require a hospital stay again within 30 days of leaving.

"Unplanned readmissions to hospitals are both costly to health care providers and disruptive to patients and their families," the Wisconsin Hospital Association said in its 2022 quality report released in August.

Patients who fall under the program are those with heart failure, heart attacks, chronic obstructive pulmonary disease, coronary artery bypass grafts, and knee and hip replacements. Pneumonia is usually included, but Medicare excluded it this year because of overlap with COVID-19.

UW Hospital has numerous programs aimed at reducing readmissions, said Dr. Jeff Pothof, chief quality officer for UW Health. The 0.16% penalty this year amounts to $167,000. The highest penalty the hospital could receive is about $4 million.

Pothof said the efforts include home or telehealth visits after discharge for the frailest patients and nurse care coordinators at clinics and nursing homes. The hospital also attempts to get prompt clinic visits for discharged patients who end up in the emergency room and include family members or caretakers when discharge instructions are shared with patients as they leave the hospital.

Pothof said readmissions involve many types of health care settings, along with social issues such as housing stability, transportation needs, availability of food and alcohol use.

"Readmissions has been one of our more difficult things to get consistent improvement on," he said. "It requires the most cross-functional work of anything we try to improve in the health system."

Medicare is a powerful leverage tool in health care. It accounted for 46.2% of patient revenue at Wisconsin hospitals last year, with commercial insurance accounting for 33.9% and Medicaid making up 14.8%.

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