WMC losing a portion of its Medicare funds

Posted: October 3, 2012

The Winchester Star

Because of Medicare patient readmissions, Winchester Medical Center is to pay up to $150,000 in penalties. This will result from 0.01 percent being deducted from each Medicare inpatient reimbursement until October 2013. Pictured is the north tower at the center. (Photo by Scott Mason/The Winchester Star)

WINCHESTER — Winchester Medical Center will lose Medicare funding over the next year due to the number of its patients being readmitted to the hospital shortly after being discharged.

WMC will have 0.01 percent deducted from each Medicare inpatient reimbursement until October 2013.

The penalty is expected to cost the hospital $100,000 to $150,000 for the year, according to Dr. Nicolas C. Restrepo, vice president of medical affairs.

As a part of the 2010 Affordable Care Act that went into effect Monday, hospitals are penalized for readmission rates above the national average as part of a strategy to lower health care costs and improve care.

WMC’s penalty compares favorably with other Virginia hospitals.

The average penalty for the 77 state hospitals that receive Medicare funding was 0.49 percent.

But Restrepo isn’t satisfied, calling WMC’s penalty “an opportunity to improve.”

The hospital has instituted a wide range of efforts to keep patients from having to return — even starting a transition coach program that targets those with a high risk for readmission, Restrepo said.

The program emphasizes staying in touch with patients over the phone or home visits to answer questions and encourage adhereance to discharge instructions.

WMC has also partnered with outside organizations such as Meals on Wheels, free medical clinics, area councils on aging and others who provide transportation to medical appointments.

“They’re better off at home than they are at the hospital,” Restrepo said.

Warren Memorial Hospital in Front Royal — also a Valley Health-run facility — will not be penalized.

Rockingham Memorial Hospital in Harrisonburg will lose 0.82 percent.

The maximum a hospital could be penalized is 1 percent. In October 2013, the maximum percentage will increase to 2 percent, and by October 2014 it will be 3 percent.

Nationally, nearly one in five Medicare patients return to the hospital within a month of discharge, costing Medicare $17.5 billion in additional bills each year, according to Kaiser Health News.

To count against readmission, patients did not have to be rehospitalized at the same hospital or for the same condition.

Medicare weighted the sickness of patients in its calculations of whether the rates were higher than those of the average hospital, but racial and socioeconomic factors were not included.

The government’s penalties are based on the frequency that Medicare heart failure, heart attack and pneumonia patients were readmitted within 30 days from July 2008 to June 2011 — although hospitals are held accountable for the returning patients no matter the reason they come back.

More sickness categories will be added in coming years, Restrepo said.

— Contact Conor Gallagher at cgallagher@winchesterstar.com