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CaroMont Avoids Medicare Penalty

10-27-2014

Orr, Adam. (2014 October 24). Ahead of Curve. CaroMont Avoids Medicare Penalty. The Gaston Gazette

CaroMont Health has changed the way it treats and monitors patients over the past three years — changes the nonprofit’s leaders say will help avoid stiff federal Medicare fines in 2015.

CaroMont paid combined Medicare fines of more than $214,000 in 2013 and 2014. Those penalties come in the form of reduced Medicare reimbursements. But the health-care system will pay no such penalties in 2015 thanks to a decrease in the number of patients it readmitted in recent years.

Since 2012, Medicare, the federal senior insurance program, has punished hospitals that readmit high numbers of patients with certain conditions.

If those people are admitted into the hospital more than once in 30 days, the hospital gets paid less for the second stay and each one thereafter.

The fines focus on patients treated for chronic lung diseases, pneumonia, hip and knee replacements, heart attacks and heart failure.

The government’s goal?

The system is aimed at reducing the number of patients who return to hospitals after receiving treatment, a strategy Medicare hopes will improve the care patients receive and reduce costs for taxpayers.

Peggy Blackburn, CaroMont Health’s director of case management services, said an emphasis on reducing readmissions is an effective way to improve both areas.

What’s changing?

Blackburn said CaroMont has adjusted how medical professionals treat patients at CaroMont Regional. But the crucial difference, she says, includes more carefully tracking what happens to patients after they’ve been released from the hospital.

“Readmissions are about a lot of different factors,” Blackburn said. “It depends on how sick a patient is, what happens during their hospital visit, at discharge and after they leave the hospital.”

Major changes include:

1. A team of nurses — experts in disease management — who monitor high-risk patients for up to 30 days after they leave the hospital. Blackburn called this change crucial because patients are monitored for follow-up visits and some patients are even visited at home.

2. A team of CaroMont doctors examined why patients return to the hospital after receiving treatment. That same team then made changes in how patients are discharged.

3. Certain patients are followed after they’ve moved to a nursing home or skilled nursing setting, and hospital staff makes recommendations for further care.

4. CaroMont has also employed transitional care pharmacists to make sure discharged patients receive the proper medications.

Could CaroMont face penalties again in the future?

Yes. Blackburn said the steps CaroMont has taken are necessary, but the non-profit will have to monitor readmission rates for a growing number of illnesses and procedures, including COPD this year.

Next year the penalties will be based on readmissions for patients with coronary bypass surgery and strokes as well as all the previously monitored conditions.

“We’ll have to continue to evolve,” Blackburn said. “So we’re rolling out any improvements or best practices to include all patients — and not just ones that are subjected to penalty.”

How does CaroMont feel about the plan?

The local health-care system supports the government’s focus on reducing readmissions,says Alex Mullineaux, CaroMont’s director of public affairs. But he says social and economic factors affecting a hospital’s patients should be considered when determining which hospitals should be penalized for excessive admissions.

“Some hospitals like CaroMont Regional deal with tough conditions that are not being taken into account,” Mullineaux said. “Right now (Medicare) doesn’t look at overall socioeconomic conditions.”

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