Two-thirds of Georgia hospitals facing Medicare penalties for excessive readmissions

By Andy Miller - For the AJC



Piedmont Henry Hospital in Stockbridge. (Photo / Piedmont Healthcare)

Medicare plans to fine two-thirds of Georgia hospitals for having too many patients return within a month for additional care, federal data show.

The 67 percent of Georgia hospitals facing penalties is higher than the national average of 54 percent, according to a Kaiser Health News analysis.

The readmission penalties, part of the Affordable Care Act, encourage hospitals to pay closer attention to what happens to patients after discharge.

Since the fines began, national readmission rates have declined, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month of being released, Kaiser Health News reported.

The fines will be applied to Medicare payments when the federal fiscal year 2016 begins in October. In this round, the average Medicare payment reduction is 0.61 percent per patient stay. Georgia’s average penalty is 0.47 percent.

The maximum possible fine is 3 percent. The highest fine in the state, 2.59 percent, will be assessed against Piedmont Henry Hospital in Stockbridge.

The fines are based on readmissions between July 2011 and June 2014 and include Medicare patients who were originally hospitalized for heart attack, heart failure, pneumonia, chronic lung problems or elective hip or knee replacements.

The Georgia Hospital Association said Tuesday it sees progress on readmission rates. The organization said 32 states have a higher average penalty than Georgia. And of the 89 Georgia hospitals that will be penalized, 57 will see their penalties decrease from fiscal 2015 levels, GHA said.

“Although many hospital readmissions are outside of the control of the hospital, Georgia hospitals take these reports very seriously and continue to work diligently in making improvements in areas that can be controlled,” Dr. Doug Patten, chief medical officer for GHA, said in a statement.

Hospitals facing stiffest penalties

The federal government will assess penalties against dozens of Georgia hospitals in fiscal 2016, which begins in October, for excessive readmission of Medicare patients. The penalty is expressed as a percentage of the hospital's total reimbursement from Medicare for inpatient care. The maximum penalty per year is 3 percent.

Hospital	Location	FY15 penalty	FY16 penalty
1. Piedmont Henry Hospital	Stockbridge	0.75 %	2.59 %
2. Houston Medical Center	Warner Robins	2.13 %	1.95 %
3. Elbert Memorial Hospital	Elberton	2.39 %	1.53 %
4. Chestatee Regional Hospital	Dahlonega	1.45 %	1.37 %
5. Fannin Regional Hospital	Blue Ridge	3.00 %	1.30 %
6. University McDuffie County	Thomson	0.45 %	1.20 %
7. Spalding Regional Hospital	Griffin	0.95 %	1.13 %
8. Habersham County Medical Center	Demorest	0.54 %	1.07 %
9. Colquitt Regional Medical Center	Moultrie	0.64 %	1.04 %
10. Archbold Memorial Hospital	Thomasville	0.71 %	0.88 %

Source: U.S. Centers for Medicare and Medicaid Services

This article was done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Andy Miller is CEO and editor of Georgia Health News.