TUPELO • Baptist Memorial Health Care and North Mississippi Health Services had hospitals hit by Medicare readmission penalties for the coming fiscal year.
No one wants to be penalized, but physician leaders with both systems said the Medicare initiative has spotlighted the needs of patients as they leave hospital care.
“This tells me where I need to be focused,” said Dr. Henry Sullivant, Baptist Memorial Health Care vice president and chief medical officer. “We really had to think about (readmission) in its entirety.”
It’s better for patients and their families who benefit from clearer instructions as they leave the hospital and more support when they get home, White said. It’s better financially for individuals, and taxpayers because inpatient care is among the most expensive in the health system. It’s better for communities, because hospitals are having to think beyond their walls.
“The thinking behind it is solid,” although there are ways the program could be improved, said Dr. C.K. White, North Mississippi Health Services chief medical officer. “It has encouraged us to find a way to keep readmissions low.”
The benchmark for excess, unplanned readmissions – returning to the hospital within 30 days of discharge – is a moving target.
“The whole country is getting better,” Sullivant said.
Because of the lag time in compiling data, the hospitals have already made adjustments by the time the penalties are announced. The 2020 fiscal year penalties were determined using data from July 1, 2015 to June 30, 2018.
“It can be discouraging,” for staff members working hard to address the issue, Sullivant said. “You have to look forward.”
By the numbers
Ten hospitals in Northeast Mississippi and 51 in the state have been assessed penalties between .01 and 2.34 percent of its Medicare reimbursement for the 2020 fiscal year. Nationally, 83 percent of hospitals were penalized up to 3 percent.
No Mississippi hospitals were assessed penalties for hospital-acquired conditions, which could have cost another 1 percent of Medicare reimbursements.
Tupelo-based NMHS had five of its seven hospitals penalized. Memphis-based Baptist Memorial Health Care, which has 18 general hospitals in its system, had two other Mississippi hospitals outside 16-county North Mississippi region assessed penalties. It had five others in Tennessee and Arkansas assessed penalties.
Smaller community hospitals tend to have lower penalties in part because they are measured only on the services they have. They typically don’t offer bypass surgery or manage the care for heart attacks beyond transferring patients to cardiac centers. Complex cases typically get transferred to regional referral hospitals. However, the smaller hospitals do have to contend with limited community resources, like shortages of primary care practices and few, if any, specialists, Sullivant said.
Critical access hospitals, like NMMC-Pontotoc, are not included in the readmission reduction initiative, White said.
Magnolia Regional Health Center in Corinth had the highest penalty, 2.34 percent, in the state for the 2020 fiscal year. Since 2015, it has faced penalties between 1.09 and 2.34 percent.
“Over the past few months, the hospital board has worked to bring a new executive team to the organization,” said John Harding, chief executive officer at Magnolia Regional Health Center. “Both the board and executive team are aware of the issue and are working to identify and improve the overall readmission rate at our hospital. This is not an immediate fix, but we ensure continued progress will be made.”
Magnolia did not provide financial data on the penalties or an estimate of what the 2020 fiscal year penalty will cost the hospital.
Baptist Memorial-North Mississippi in Oxford has seen penalties ranging from .14 to .79 percent since 2015. The .7 percent penalty for the 2020 fiscal year is estimated to be $293,000, Sullivant said.
Baptist Memorial-Union County has seen penalties from .06-1.29 since 2015. Its 2020 fiscal year penalty, .34 percent, is estimated to cost $13,000, Sullivant said.
Baptist Memorial-Booneville has seen penalties from .01 to .25 percent, with two years without any penalties. It’s 2020 fiscal year penalty, .19 percent, is estimated to cost $9,000, Sullivant said.
Baptist Memorial has focused on expanding its communication with patients, families and their medical providers. The goal is to have more seamless transitions between hospital and the next step, whether it’s home, a nursing home or rehabilitation center.
“We need to all be looking at patient care from the same lens,” Sullivant said.
Baptist Memorial is also working to leverage its Epic electronic medical records to better communicate with those who will care for the patient.
It also means building partnerships with community organizations that can help address social determinants of health, like having adequate access to food, transportation and social services.
“We really have to think about it in its entirety,” Sullivant said. “Closing the loop is key.”
For North Mississippi Health Services, the total amount of the penalties projected for the 2020 fiscal year is less than .0005 percent of our annual total revenues as a system, according to NMHS President and Chief Executive Officer Shane Spees.
Total revenue for North Mississippi Health Services was $52.4 million for the 2017 fiscal year, according to its 2016 IRS 990 form, the most recent available publicly.
NMMC-Amory Gilmore, which formally joined the NMHS family in January, has seen penalties between .47 and .76 percent since 2015.
NMMC-Tupelo has seen penalties ranging from .12 to .61 percent since 2015. NMMC-West Point has been assessed penalties from .70 to .03 percent since 2015. It has the lowest readmission penalty of the 10 hospitals assessed in the 16-county Northeast Mississippi region.
NMMC-Iuka has seen penalties between .15 and .60 percent since 2015, including two years when the hospital was not assessed any penalties.
It is challenging, because hospitals can’t control what happens when patients leave the four walls of the hospital, White said.
There’s been a great deal of effort to improve discharge planning, provide better instructions for patients and families and devote more resources to making sure patients have the follow up care they need, White said. Through a clinically integrated network, the system is trying to better connect independent physicians and nurse practitioners, so they have more information about their patients’ hospital stays and post-discharge needs.
NMHS is using population health and transition care nurses to check on patients who are at particularly high risk of readmission.
In September, the NMMC-Tupelo started a program with CipherOutreach. It uses automated calls to reach patients discharged from the hospital and emergency department to identify patients who need additional assistance. Dedicated clinicians follow up to resolve the issue.
“It’s an outgrowth of the need,” White said.