Medicare reduces payments to 120 Illinois hospitals

Nancy Chen, News Editor

In an effort to improve patient care, Medicare plans to penalize 94 percent of hospitals in Illinois for unnecessary patient readmissions. This reduction program takes effect Oct. 1, 2015.

According to Crain’s Chicago Business, hospitals nationwide will be docked up to three percent of their Medicare payments if patients  return for additional treatments within 30 days at rates higher than the national average. These measures, mandated by the Affordable Care Act, will pressure  hospitals to provide better care to patients and more services, such as nursing facilities, after discharge.

Centers for Medicare and Medicaid Services Medical Officer Dr. Patrick Conway hopes the program will incentivize hospitals to target key issues.

“We want hospitals focused on patient safety,” Conway said. “And we want them laser-focused on eliminating patient harm.”

Medicare scores hospitals’ readmission rates on five ailments, which are pneumonia, heart attacks, heart failures, hip or knee replacements, and chronic obstructive pulmonary disease. Only seven Illinois hospitals either met or fell below the national rates. The most heavily penalized Illinois hospital, Ingalls Memorial Hospital, will lose 2.94 percent of its reimbursements due to its higher than average readmission rates in all five categories.

According to the Chicago Tribune, the readmissions amount to one percent of Medicare payments every year.

Senior Bhargavi Dhanireddy believes the excessive patient readmissions are necessary for the patients’ health.

“You can’t find everything wrong with the person the first time they come,” Dhanireddy said. “I understand they are trying to make the doctors more accountable for their actions, but the medications might not work the first time so they have to come back.”

Some hospitals argue that the excessive readmissions are also based on uncontrollable factors such as a patient’s socioeconomic status. West Virginia Senator Joe Manchin introduced a bill in June that calls for Medicare to account for such socioeconomic factors and decrease the reimbursement penalties.