Nationally, Medicare is reducing payments to 2,499 hospitals, about 47% of all facilities, with the average penalty being 0.64%, according to a report by Kaiser Health News (KHN).

Rockville General Hospital Photo.

Rockville General Hospital received the largest penalty from CMS for readmissions.

This year’s penalties were based on tracking patients from July 1, 2017 through Dec. 1, 2019, so the influx of patient care during the pandemic is not included, CMS said.

In Connecticut, 72 % of all hospitals in the program will face a loss in CMS payments, beginning October 2021 through September 2022.

No Connecticut hospital received the maximum penalty of 3%. But Rockville General Hospital will lose 2.3%, the highest penalty of any Connecticut facility; and Bridgeport Hospital will lose 2.15%.

Five hospitals will lose more than 1% of their funds, 19 others less than 1%.

“Connecticut’s hospitals share a strong commitment to the quality of care they provide and to patient safety.  Through the Connecticut Hospital Association, hospitals drive quality improvement through a shared commitment to best practice and clinical collaboration and we are always striving to do better,” said the CHA in a statement.

“Hospitals have been operating under tremendous strain in response to the COVID-19 pandemic while continuing to focus on quality improvement. We are encouraged that many hospitals showed improvement and we will maintain our focus on the quality of care delivered at hospitals across the state,” CHA said.

“This measure, and the results among Connecticut hospitals, demonstrate the need for a higher degree of coordinated care after hospitalization. This is a time when a discharged patient is particularly vulnerable to complications related to their recent hospitalization and when thorough, accurate, and understandable care instructions, new supplies, clarity and access to all medications and oversight of care are particularly important to their continued recovery.”

— Lisa Freeman, executive director

Connecticut Center for Patient Safety

Freeman said that while readmission measures have “the potential to slightly mislead patients because the readmission that is being counted can be for any reason, not only the reason for the initial hospitalization, it still addresses the wellness, or un-wellness of the patient at discharge.”

CHA has launched Unite Connecticut to improve hospital readmission rates.  Under the program, “hospitals now have direct referral and communication loops, through a shared digital platform, to refer and support patients in need of community-based social services to help stabilize their living conditions and optimize their health. “

This year, the program has served more than 3,600 patients through referrals to about 280 community-based organizations. “We expect these robust support channels will help patients to realize better health outcomes, by addressing the social drivers of health. Over time, taking down those social barriers supports a patient’s ability to fully follow a course of treatment or make a necessary lifestyle change, reducing the need for readmission and also improving the patient’s health outcomes,” the CHA said. There are 11 hospitals participating and CHA said five more are in the process of joining.

The hospitals receiving penalties of over 1% are: Manchester Memorial, 1.8%; Middlesex, 1.67%; William Backus, 1.56%; Bristol, 1.34%; and Waterbury, 1.13%.

The 19 hospitals losing less than 1% reimbursement are: Charlotte Hungerford, .38%; Danbury, .31%; Day Kimball, .27%; Greenwich, .53%; Griffin, .02%; Hartford, 0.57%; John Dempsey, .78%; Johnson Memorial, .67%; and Lawrence + Memorial, .08%;

Also, Mid-State Medical, 0.45%; Norwalk, 0.74%; St. Mary’s 0.62%; Sharon, 0.02%; St. Francis, 0.56%; St. Vincent’s, 0.41%; Stamford, 0.22%; Hospital of Central Connecticut, 0.64%; Windham Memorial, 0.08%; and Yale New Haven, 0.76%.

Only two facilities received no penalty: Masonicare Health Center in Wallingford and Hebrew Home and Hospital Inc. in West Hartford.

Eight Connecticut hospitals are exempt from the program. They are: Connecticut Children’s Medical Center in Hartford, Connecticut Valley Hospital in Middletown, Natchaug Hospital in Mansfield, Connecticut Mental Health Center in New Haven, Southwest Connecticut Mental Health in Bridgeport, Silver Hill Hospital Inc. in New Canaan, the Connecticut Hospice Inc. in Branford, and Albert J. Solnit Children’s Center in Middletown.

This is the 10^th year for CMS penalties, enacted under the Affordable Care Act (ACA).

To review Kaiser Health News’ data on hospital penalties over several years go here.

Statewide, 26 of the 29 hospitals evaluated – 90 percent – will have their reimbursements reduced, by varying amounts, in the 2020 fiscal year that began Oct. 1, according to a Kaiser Health News analysis of data from CMS.

CMS began in the 2013 fiscal year to penalize hospitals that have high rates of patients who are readmitted within one month of being discharged. The penalties were enacted as part of the Affordable Care Act, intended to encourage better health care delivery. Nationwide, 2,583 hospitals will be penalized this year, according to Kaiser Health News.

CMS penalized Bridgeport Hospital 2.66 percent, the highest penalty among CT hospitals.

To help reduce the rate of readmissions, the Connecticut Hospital Association will be working with hospitals to partner with community-based organizations to address social determinants of health including housing, transportation, food insecurity and access to medical providers, said Mary Cooper, chief quality officer and senior vice president for clinical affairs at CHA.

“It’s not just about what happens at the hospital,” said Cooper.

In Connecticut, no hospital received the maximum penalty of a 3 percent reduction in reimbursements, but several will see payments reduced by more than 2 percent.

They are: Bridgeport Hospital with a 2.66 percent penalty, Waterbury Hospital at 2.44 percent, Manchester Memorial Hospital at 2.38 percent; and Bristol Hospital at 2.23 percent. Each of those hospitals were penalized in the 2019 fiscal year as well and, in each case, this year’s penalty is greater.

Medicare levied a 0.78 percent penalty on Yale New Haven Hospital and a 0.50 percent penalty on Hartford Hospital. Both penalties were lower than the previous year, St. Francis Hospital and Medical Center’s penalty was slightly higher at 0.39 percent.

Sharon Hospital has the lowest penalty, at 0.02 percent, followed by William W. Backus Hospital in Norwich and Windham Community Memorial Hospital & Hatch Hospital, which each will be penalized 0.03 percent.

Three hospitals in the state weren’t penalized at all: Stamford Hospital, Hebrew Home and Hospital Inc. in West Hartford, and Masonicare Health Center in Wallingford. Stamford Hospital and Hebrew Home and Hospital had no penalties last year as well.

Waterbury Rep-Am Photo.

Waterbury Hospital’s penalty is 2.44 percent.

Some hospitals are making strides in reducing readmissions, but doing so is a complex challenge, said Lisa Freeman, executive director of the Connecticut Center for Patient Safety. And more needs to be done, she added.

“Readmissions are a huge problem but, at the same time, it’s not a problem that falls solely on one entity’s shoulders,” said Freeman. “It’s a shared burden. The solution is a hard one.”

In launching the new hospital-community partnerships, Cooper said all Connecticut hospitals have committed to a new technology-based program that will make it easier for them to refer patients to community-based resources upon discharge, and then receive reports back from those resources about how patients fared, she said.

The program will begin rolling out – not merely within hospitals, but within communities – in three areas of the state this fall, and is expected to be implemented statewide by 2021, Cooper said.

Hospitals have an obligation to the communities they serve and should learn as much as they can about patients’ living conditions and social determinants if they aim to reduce readmissions long-term, Freeman said.

“I don’t think it’s fair to necessarily pick on particular hospitals,” she added. “We really, really have to all work together. [In some cases] we’re not going to get patients out of that cycle [of readmissions] unless we get them out of their environment.”

CMS’ reimbursement penalties alone aren’t significantly reducing the number of readmissions, Cooper noted, but a more community-based approach could.

“Given the number of hospitals that are penalized across the country, and given the lack of movement in the metrics of readmission, we have to look for other strategies,” she said, noting all hospitals want to reduce readmissions. “It’s on everybody’s radar. Everybody is working on it across the board.”

Register-Citizen Photo.

Sharon Hospital received the lowest penalty at 0.02 percent.

“The good thing of this whole program is that it’s caused folks in the industry to look at this whole issue differently. It’s caused them to be a little creative – for the most part, in good ways,” Freeman said. “I think the shift is occurring very, very slowly. We have to start looking at this as a human problem, not a dollar and cents problem, and not a numbers problem.”

Medicare exempts some hospitals from the penalty program, including children’s hospitals, psychiatric hospitals and veterans’ hospitals. Nationwide, 2,142 hospitals were exempt this year.

In Connecticut, exempted hospitals are: Connecticut Children’s Medical Center in Hartford, Connecticut Valley Hospital in Middletown, Natchaug Hospital in Mansfield, Connecticut Mental Health Center in New Haven, Southwest Connecticut Mental Health in Bridgeport, Silver Hill Hospital Inc. in New Canaan, the Connecticut Hospice Inc. in Branford, and Albert J. Solnit Children’s Center in Middletown.

View the hospital penalties provided by Kaiser Health News here.

The hospitals are among 769 nationwide that will lose one percent of their Medicare reimbursements this year as part of the Centers for Medicare and Medicaid Services’ (CMS) Hospital-Acquired Condition Reduction Program.

This is the third year in a row that Bridgeport Hospital has been penalized.

The CMS program, now in its third year, penalizes the lowest-performing hospitals where a relatively high number of patients got infections from hysterectomies, colon surgeries, urinary tract catheters and central line tubes. It also takes into account patients who suffered from blood clots, bed sores or falls while hospitalized.

New this year, CMS also factored in the incidents where antibiotic-resistant bacteria – namely, methicillin-resistant staphylococcus aureus (MRSA) and Clostridium difficile (C. diff) spread.

Slightly fewer Connecticut hospitals are being penalized this year than last year; 18 lost a portion of their Medicare payments in 2016.

Hospitals being penalized this year include some of the state’s largest, such as Hartford Hospital and St. Francis Hospital and Medical Center in Hartford, and Yale New Haven Hospital and Bridgeport Hospital. But smaller hospitals also made the list, including Masonic Health Center in Wallingford, Charlotte Hungerford Hospital in Torrington, and Johnson Memorial Hospital in Stafford Springs.

Hospitals statewide place a strong emphasis on patient safety, and the outcomes reflect that, said Dr. Mary Cooper, vice president and chief quality officer at the Connecticut Hospital Association.

“The hospitals here in Connecticut are improving,” she said. “That’s the great news.”

Cooper said improvements are largely due to hospitals embracing “high-reliability” standards, which help staff and doctors better anticipate and prevent patient harm.

“The outcomes that we are seeing are a result of everybody paying attention and lots of knowledge being shared,” she said.

Lisa Freeman, executive director of the Connecticut Center for Patient Safety, agrees that hospital are making strides in some areas, thanks in large part to the high-reliability standards. But Freeman said, “As long as any patients are getting hospital-acquired infections and conditions, there needs to be improvement.”

Griffin Hospital is among nine hospitals that have never been penalized under this program.

“The good news that comes out of this is that when hospitals focus on fixing a particular problem, they come up with solutions,” Freeman said. “But there’s still all the other specific areas” that need attention.

Seven Connecticut hospitals have been penalized in all three of the years since the program launched, according to CMS. They are: Bridgeport; Connecticut Hospice Inc. in Branford; Hartford; the Hospital of Central Connecticut in New Britain; John Dempsey Hospital in Farmington; Windham Community Memorial Hospital and Yale New Haven.

Additionally, four other hospitals are being penalized in 2017 for the second consecutive year: Charlotte Hungerford, Lawrence + Memorial Hospital in New London; St. Mary’s Hospital in Waterbury, and St. Francis Hospital.

There are nine hospitals that have never been penalized under this program. They are: Bristol Hospital, Connecticut Children’s Medical Center in Hartford, Griffin Hospital in Derby, Hebrew Home & Hospital in West Hartford,  MidState Medical Center in Meriden, Milford Hospital, Sharon Hospital, St. Vincent’s Medical Center in Bridgeport, and William Backus Hospital in Norwich.

High-reliability standards began rolling out in Connecticut in 2013, and to date, more than 50,000 health care workers statewide have received training in the program, Cooper said. The practice is spreading, and other states are looking to Connecticut as a model, she added.

High-reliability involves making concerted efforts to keep patients safe – such as double-checking dosages before administering medications, taking “timeouts” during surgeries to make sure procedures are being correctly, and implementing safety checklists.

“I commend the hospital association for putting their efforts into the high-reliability practice,” Freeman said. “High-reliability is a great strategy to use. It’s wonderful for processes and treatment, and situations where there is a lot of consistency in what needs to be done. It’s one piece of the answer.”

Yale New Haven Hospital has been penalized all three years.

But more must happen to ensure that patients aren’t getting infections while hospitalized, she said. A further culture shift is needed so that hospital employees value patient input and feedback, she said, and hospitals need to focus on the over-prescription of antibiotics, since a growing number of bacteria are becoming resistant to them.

Hospitals also should reiterate to employees how effective simple hand washing can be in preventing the spread of bacteria and infections, Freeman said.

Hospitals have taken many positive steps, she said, “but it’s not enough yet.”

To view the CT hospital penalties click here.

Four of the 23 hospitals will lose the maximum amount allowed under the federal policy: 1 percent of their base Medicare reimbursements. They are the Hospital of St. Raphael in New Haven, Griffin Hospital in Derby, Masonic Home and Hospital in Wallingford, and MidState Medical Center in Meriden.

Three others will lose close to the maximum amount: Yale-New Haven Hospital, Bristol Hospital and St. Vincent’s Medical Center in Bridgeport, according to data compiled by the Centers from Medicare & Medicaid Services (CMS) and Kaiser Health News.

Eight of the state’s 31 hospitals, including Hartford Hospital, Middlesex Hospital and Backus Hospital, will face no penalty.

The 23 Connecticut hospitals are among more than 2,200 nationwide that will be penalized by the federal government, starting in October, under provisions in the 2010 federal health care law. A total of 278 hospitals nationally will lose the maximum amount allowed; others will lose fractions of 1 percent of their Medicare funding.

Federal officials have been concerned about 30-day readmission rates for patients who are hospitalized for three conditions: pneumonia, heart attacks and heart failure. The health reform legislation allows CMS to withhold a portion of Medicare payments to hospitals that have excessive readmissions, starting with up to 1 percent in fiscal year 2013 and rising to 3 percent in 2015—penalties that could reach millions of dollars for some hospitals.

Because the penalties are based on readmissions between July 2008 and June 2011, officials of many Connecticut hospitals said they had anticipated losing some Medicare funding. Most hospitals in the state have committees working on initiatives to reduce readmission rates, with a focus on improving the transition from inpatient to community care.

At St. Raphael’s, which is merging with Yale-New Haven, Jim Judson, director of quality improvement said in an earlier interview that an interdisciplinary team is working to improve the transition to post-hospital care and is providing patients with easy-to-understand information about the symptoms and care of pneumonia and heart conditions. Judson and other administrators have noted that inner-city hospitals often treat patients with co-morbid conditions that can land them back in the hospital after discharge. Readmissions are counted no matter why the patient returns within 30 days. That means if a patient discharged after treatment for pneumonia returns to the hospital within 30 days with a broken hip, the new admission is counted against the hospital.

Nationally, about 20 percent of hospitalized Medicare patients are back within 30 days, at an estimated cost of $17 billion a year, according to the Medicare Payment Advisory Commission.

Some health care experts have said they expected hospitals that serve large numbers of low-income people to be hit hardest by the penalties, because of problems ensuring that patients follow through with doctors and medication after discharge.  A number of such hospitals show up among the 278 that received the maximum penalty, including, St. Elizabeth’s Medical Center in Boston and Montefiore and Maimonides medical centers in New York.

The other Connecticut hospitals that faced no penalties were: the Hebrew Home and Hospital in West Hartford, Manchester Memorial Hospital, Rockville General Hospital, Sharon Hospital and Windham Community Memorial Hospital.

To read previous report: Hospitals To Face Penalties For Higher Readmissions click here.