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U.S. Centers for Medicare & Medicaid Services penalizes 10 Idaho hospitals

St. Joseph Regional Medical Center in Lewiston, Idaho

St. Joseph Regional Medical Center. File photo

The U.S. Centers for Medicare & Medicaid Services announced on Jan. 28 that it will cut 2020 payments to 10 Idaho hospitals with high readmission rates.

Two of those hospitals, Northwest Specialty Hospital in Post Falls and St. Joseph Regional Medical Center in Lewiston, will also receive a patient-safety penalty reduction on all Medicare payments for the 2020 fiscal year.

Two of the penalized hospitals received five-star ratings from CMS, which were also announced on Jan. 28: St. Luke’s Regional Medical Center in Boise and Portneuf Medical Center in Pocatello.

The number of Idaho hospitals receiving readmission penalties jumped up to 10 for 2020 compared to six the year before. This is the highest number of penalties for Idaho’s hospitals since the program began in 2015. For 2015 through 2018, an average of five Idaho facilities received readmission penalties.

The 2019 and 2020 readmission payment penalties are listed below. A blank means that no penalty was levied during the designated federal fiscal year.

Hospital Percent per-patient penalty
2019 2020
Northwest Specialty Hospital, Post Falls 3% 2.98%
Madison Memorial Hospital, Rexburg 0.44% 0.9%
West Valley Medical Center, Caldwell 1.88% 0.79%
Saint Alphonsus Regional Medical Center, Boise   0.41%
Eastern Idaho Regional Medical Center, Idaho Falls   0.37%
Portneuf Medical Center, Pocatello   0.28%
Saint Alphonsus Medical Center – Nampa 0.33% 0.22%
St Joseph Regional Medical Center, Lewiston   0.15%
St Luke’s Nampa Medical Center   0.04%
St Luke’s Regional Medical Center, Boise   0.02%
St Luke’s Magic Valley, Twin Falls 0.03%  
Kootenai Health, Coeur D’alene 0.11%

Source: Kaiser Health Foundation

The penalties are a feature of the Affordable Care Act. Their intent is to encourage better care. The penalty program is now in its sixth year. According to Kaiser Health News, hospital infections are decreasing overall; however, it is difficult to attribute that trend to the penalties.

For the readmission penalties, Medicare can cut up to 3% for each patient’s payment, although the average penalty is usually less than that. For example, if a hospital incurred the maximum penalty of 3%, then for every dollar a hospital billed Medicare for a patient’s care, CMS would only pay 97 cents.

The patient safety penalties are a straight 1% reduction of all Medicare payments to a hospital for the federal fiscal year, which runs from October through September.

The penalties are controversial. Many of the rules are perceived as unfair, especially for safety-net hospitals that serve a disproportionate number of lower-income, under-insured and uninsured patients. Such patients have a higher risk of readmission and infection due to factors beyond hospital control.

In an attempt to address this and other issues, Congress passed legislation in 2018 in an attempt to address the disparities in the penalty decision process. Regardless of tweaking the penalty scheme, CMS is still required by the Affordable Care Act to punish the quarter of general care hospitals that have the highest rates of patient safety issues.

“There is limited evidence that this is the kind of program that makes things better,” commented Andrew Ryan, a professor of health care management at the University of Michigan School of Public Health, in Kaiser Health News.

CMS penalty data is available through the Kaiser Health News look-up tool or through cms.gov for archived readmission and patient safety data.

About Catie Clark