Hospitals across Ventura County face penalties for readmission of Medicare patients
Tom KiskenSix hospitals in Ventura County face federal penalties because of the volume of Medicare patients readmitted within 30 days of being discharged for pneumonia, heart attacks and other illnesses.
St. John's Pleasant Valley Hospital in Camarillo, Los Robles Health System in Thousand Oaks, Ventura County Medical Center in Ventura, Adventist Health Simi Valley, St. John's Regional Medical Center in Oxnard and Community Memorial Hospital in Ventura all stand to lose a fraction of their reimbursement for each Medicare patient treated in the fiscal year that began Oct.1.
The penalties range from the 1.8% reduction faced by St. John's Pleasant Valley to a 0.02% cut at Community Memorial, according to a data analysis by Kaiser Health News.
None of the area hospitals face the maximum 3% penalty in an eight-year-old Centers for Medicare & Medicaid Services program that uses financial sanctions as leverage to reduce the number of elderly patients who bounce back into the hospital.
Each of the six area hospitals faces penalties for the fifth consecutive year.
According to Kaiser Health News, 83% percent of the hospitals evaluated nationwide face penalties in the program. In California, 74% of the hospitals are being penalized.
The revolving door of readmissions is a huge issue and can mean patients aren't getting what they need, said Dr. Kevin Kavanagh, board chairman of the Health Watch USA patient advocacy program.
The penalties, he said, help counter-balance Medicare payment methodology that encourages shorter hospital stays.
"Patients may be discharged too soon to maximize profitability," he said. "They could suffer undue harm."
The federal program focuses on patients originally treated for hip and knee replacements, chronic lung disease, heart failure, pneumonia and coronary artery bypass graft surgery. Hospital industry representatives noted hospitals are dinged for any readmissions within a month even if they are not directly related to the original condition.
More:St. John's Pleasant Valley Hospital addition opens in Camarillo
Some observers contend hospitals are left between a rock and a hard place.
"If a person stays in the hospital longer, it just costs the hospital money," said Dr. Jeffrey Allan, a Camarillo physician who treats aging patients. He added that the frail conditions of some people means readmission may be unavoidable.
"No matter what you do a patient is going to get sicker and they're going to end up in the hospital," Allan said.
Kavanagh voiced support for the penalties, contending they help explain why readmission rates have dropped nationwide. He said hospitals that struggle with readmission every year need to figure out how to get themselves out of a rut.
Some facilities are strapped for the resources needed to improve care. But Kavanagh also cited reports and studies about the rising compensation nationwide of chief executives at nonprofit hospitals.
"All of these penalties are occurring when nonprofit CEO salaries are coming under more scrutiny," he said. "I do think more resources need to be devoted to the patients."
More:Hospitals struggle to find shelter for discharged homeless patients
The exact amount of reduced reimbursement depends on the amount of Medicare claims made by a hospital. But the penalties can gain a hospital's attention.
At St. John's Pleasant Valley, the hospital's net inpatient revenue for patients covered by traditional Medicare exceeded $35 million in 12 months ending in June 2018, according to records from California's Office of Statewide Health Planning and Development.
The fiscal year 2020 penalties were calculated in a complex formula involving readmissions from 2015 to 2018. Hospitals were evaluated in tiers of similar facilities based on proportions of patients eligible for both Medicare and the Medicaid insurance program for low-income people.
The tiers make it hard to compare one hospital's penalty to a facility in a different tier even if they're in the same county.
More:Hospitals around the area receive patient safety grades ranging from A to D
Patient demographics also can affect readmissions. More than 40% of the patients at St. John's Pleasant Valley Hospital in Camarillo are 80 or older, said Megan Maloney, a hospital spokeswoman. About 15% are 90 or older.
When they are released from the hospital, they often rely heavily on a caregiver who may be a spouse or a family member.
"Our reality is that these are older patients and the caregiver that is taking care of them is an an older person," said Maloney, suggesting that relieving some of the pressure on the caregiver could improve care and readmission rates. "We need to just give more support to that person."
She said St. John's hospitals in Oxnard and Camarillo have submitted grant proposals aimed at providing more respite for caregivers. She also cited efforts aimed at making sure hospitals, home health care groups, nursing homes and other facilities are on the same page regarding a patient's needed care.
"We all really need to come together and look at this," she said.
Penalties by hospital
St. John's Pleasant Valley, Camarillo: 1.8%
Los Robles Health System, Thousand Oaks: 1.66%
Ventura County Medical Center, Ventura: 0.39%
Adventist Health Simi Valley: 0.29%
St. John's Regional Medical Center, Oxnard: 0.10%
Community Memorial Hospital, Ventura: 0.02%
Tom Kisken covers health care and other news for the Ventura County Star. Reach him at tom.kisken@vcstar.com or 805-437-0255.