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Hospitals Face Penalties for High Medicare Readmissions Rates

Starting this month, hospitals will not get as much money from the federal government if they have too many too many Medicare patients readmitted within a month of being discharged.  More than a hundred Pennsylvania hospitals will face this penalty.

Hospitals with high readmission rates for Medicare patients treated for heart attack, heart failure, and pneumonia who return for care within 30 days of discharge will lose up to one percent of their regular reimbursement from the federal government.

Excela Health Frick Hospital in Mt. Pleasant faces the maximum penalty. Jennifer Miele, spokesperson for Excela, says about $100,000 will be withheld this year but with the system's $500 million budget, it will not have much of an impact.

"Nearly every hospital in Western Pennsylvania is going to face the cut in reimbursement, we’re all in the same boat. That’s because we’re treating a pretty unique population," said Miele. "We have an older population in Western Pennsylvania, we have a heavy, heavy smoker rate. And that creates chronic diseases like diabetes, COPD and heart failure."

The Readmissions Reduction Program, part of the Affordable Care Act, will affect other local hospitals including UPMC McKeesport, UPMC Mercy, UPMC Presbyterian Shadyside, Western Pennsylvania Hospital, and Allegheny Valley Hospital in Natrona.

Allegheny Valley is among those facing the maximum penalty. Chief Medical Officer Tom McClure said the penalty comes despite the hospital’s falling readmission rate.

"We created this high risk care team that’s composed of a physician- myself, a home care nurse, mental health workers, a pharmacist, social worker, palliative care but we huddle on those patients every single day...it’s a team without walls," he said.

This readmissions team follows patients after discharge.

"They need something in the middle of the night…they can call that team they have the resources that they need," he said.

More than 2,000 hospitals across the country will face the penalty. The maximum penalty grows to two percent in 2013 and three percent in 2014.

This story is part of a collaboration between 90.5 WESA, NPR and Kaiser Health News.