The other issue is that Congress directed CMS to penalize the worst-performing 25% of general hospitals each year—regardless of overall HAC improvement. That guarantees that more than 750 hospitals will have Medicare payments clawed back every year regardless of performance gains.
Medicare excluded certain hospitals from scrutiny. These were hospitals that treat psychiatric patients, veterans or children. Also exempted are hospitals with the “critical access” designation for being the only provider in an area.
Hard-Hit States
According to Kaiser Health News, “This year’s punishments landed the hardest in Connecticut and Delaware, where Medicare penalized half of the evaluated hospitals. In New York and Nevada, 4 in 10 hospitals were penalized. A third were punished in Rhode Island and Georgia. (These figures do not include specialty hospitals automatically exempted from penalties: those serving veterans, children and psychiatric patients, and ‘critical access’ hospitals that are the only institutions in their area.)”
“While every state except Maryland—which is excluded because it has a different Medicare payment system—had at least one hospital punished, some got off comparatively lightly. Sixteen percent of hospitals or fewer in Alabama, Kansas, Massachusetts, Missouri, Ohio, Texas and nine other states were punished.”
Good News and Bad News
Three hundred and thirty-six hospitals, by contrast, improved their numbers from last year and avoided the penalty in 2018. They include such major academic hospital centers as Barnes Jewish Hospital in St. Louis, Brigham and Women’s Hospital in Boston, Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, Geisinger Medical Center in Danville, Pennsylvania., Hospital of the University of Pennsylvania in Philadelphia, Intermountain Medical Center in Murray, Utah, and the University of Michigan Health System in Ann Arbor.
Four hundred twenty-five hospitals were repeat offenders.
All the penalized hospitals were informed that the pay reductions would apply retroactively to Medicare payments from the beginning of the federal fiscal year in October 2017 and through the end of September 2018. Medicare will cut by 1% its payments for each patient’s stay as well as the amount of money hospitals get to teach medical residents and to care for low-income people. The total amount for each hospital depends on how much they end up billing Medicare.
2018 Medicare Trustees Report
In other news, CMS issued its annual Trustees report and the headline is that the Trust will be broke by 2026—a couple years earlier than expected.
What happens to Medicare if the Trust is depleted? The shortfall is paid by current tax income or borrowing or both.
Wasn’t the Affordable Care Act supposed to enact a series of measures to lower healthcare costs and help Medicare stay solvent?
