Medicare, the federal insurance program for seniors, has begun penalizing hospitals, including four in Alaska, that it says have too many readmissions -- people who bounce back into a hospital within 30 days of having been sent home.
The penalties are part of an effort to encourage higher quality treatment the first time around, such as making sure Medicare patients are clear on the follow-up care they need after a hospital stay.
Medicare is so far only evaluating readmissions of those who were hospitalized initially for one of three high-cost or high-volume conditions: heart attacks, heart failure and pneumonia. The evaluation covers three years, ending in mid-2011.
Penalties will take the form of a reduction in regular Medicare payments to that particular hospital over the next year.
The penalties, according to a Nov. 26 New York Times article, are being assessed against 2,217 hospitals around the country, with the highest assessment being a 1 percent reduction.
In Alaska, those assessed were the Alaska Native Medical Center, for readmissions of heart attack and pneumonia patients; Mat-Su Regional Medical Center for heart attack and heart failure readmissions; Central Peninsula General Hospital for heart failure; and the Yukon Kuskokwim Delta Regional Hospial for pneumonia.
The two big hospitals in Anchorage, Providence Alaska Medical Center and Alaska Regional, and hospitals in Juneau, Sitka and Fairbanks met all the guidelines and did not incur any penalties.
Gary Shaw, administrator of the Alaska Native Medical Center, said ANMC will get a small penalty -- "probably less than $5,000."
He said Medicare is comparing the Native Medical Center to urban hospitals, and he doesn't think the comparison makes sense.
Rural areas served by ANMC don't have the same level of medical care that a city does, Shaw said. "You can't take a shower or clean your wounds in the same way," he said.
"I think it's a good measure of quality for an urban hospital but a poor measure for rural areas."
Nonetheless, ANMC has increased attention to patients being discharged during the past year, Shaw said, including having all exiting patients talk to a nurse discharge coordinator before they leave.
Providence Alaska Medical Center has the most Medicare admissions in the state, and also has a full-time nurse to work with patients as they are discharged, said chief executive Dick Mandsager.
"Any measure that is publicly reported helps hospitals focus." Mandsager said. "We think it's important."
Shelly Roy, director of case management for Providence, said hospital staffers work with primary care doctors to make sure patients being discharged have a place to go for follow-up.
Mandsager said even though people might gripe about Medicare's new penalty system, they are dealing with diagnoses "for which we now there are things we can do to improve care after patients leave the hospital."
Almost one in five Medicare patients return to hospitals within a month, and the U.S. government pays out more than $17 billion a year for readmissions, the New York Times story said.
Central Peninsula Hospital executives said they've not been notified by Medicare of any fines. They refer patients with heart attacks or heart failure to Anchorage, said Camille Sorenson, Central Peninsula's marketing manager.
"We're a small hospital and don' have a cardiologist or heart surgeon," Sorenson said.
Mat-Su Regional Medical Center marketing manager Nicole Caldera said the hospital views the readmissions penalty as a starting point to improve. She didn't know how much their penalty would amount to.
Mat-Su Regional released a written statement that said, "As we continue our work to reduce readmissions and to continuously build on the quality of care provided at our hospital we anticipate we will see smaller penalties and that we will also attain quality incentives."
In Bethel, Donna Bach, spokeswoman for the Yukon Kuskokwim Delta Regional Hospital said they didn't find the Medicare evaluation of their pneumonia readmissions to be significant.
The pneumonia rates for the region are extremely high, Bach said.
"We're such a unique animal - a one-stop shop for the an area the size of Oregon."
Yukon-Kuskokwim executives are far more worried about potential loss of money for rural medicine in case of looming federal budget cuts, Bach said.
Reach Rosemary Shinohara at firstname.lastname@example.org or 257-4340.
By ROSEMARY SHINOHARA