Photo illustration by FS Productions.
The federal government issued 47 penalties to Minnesota hospitals for high patient readmission or hospital-related infection rates — a lower proportion than the national average, according to an analysis of federal records by Kaiser Health News.
The federal government reduces hospitals’ Medicare payments through programs aimed at increasing patient safety, enacted as part of the Affordable Care Act. In Minnesota this year, about 75% of eligible hospitals were penalized for readmissions this year, and 22% for hospital-related conditions last year — lower than the national rates of 82% for readmissions and 25% for hospital-related conditions, which have remained steady in recent years.
“Advancing the health of all Minnesotans is at the heart of what our hospitals and health systems are committed to,” Minnesota Hospital Association spokesperson Lou Ann Olson said in a statement to the Reformer. “Despite the stress our health care heroes have been under during the last 19 month — responding to a historic pandemic on top of a workforce crisis — they continue to provide exceptional care, in measurable and immeasurable ways.”
Under the Hospital Readmissions Reduction Program, Medicare payments to hospitals are cut by as much as 3% for higher-than-expected unplanned readmissions within 30 days of patients treated for six conditions: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, hip or knee replacement and coronary artery bypass graft surgery.
The calculation is based on individual hospitals’ performance compared to others with similar caseloads. Certain hospitals are exempt from the program, including psychiatric, children’s, Veterans Affairs and critical access hospitals. Ninety of Minnesota’s 138 hospitals are exempt.
In Minnesota, Regina Hospital had the highest payment reduction for readmissions this year at 0.7%, followed by Winona Health Services with a 0.48% reduction and Cambridge Medical Center with a 0.45% reduction.
Allina Health, which operates Regina Hospital and Cambridge Medical Center, said in a statement to the Reformer that safety is a top priority. Regina Hospital and Cambridge Medical Center leaders are engaged in efforts to ensure patients have safe transitions out of the hospital, according to the statement.
“This includes improving communication and care coordination to better engage patients and caregivers in discharge plans, such as proper discharge follow up care, connections to appropriate community resources, and comprehensive discharge education,” the statement said.
More than 30 of the nation’s 3,046 nonexempt hospitals received the maximum penalty of 3% this year, including seven in Texas and six in Kentucky.
The penalties have succeeded in reducing readmission rates without increasing patient mortality, according to an analysis by the Medicare Payment Advisory Commission. In 2008, nearly a quarter of all heart-failure patients, for instance, were readmitted to the hospital, compared to fewer than 21% in 2017.
The average penalty per hospital in 2018 was $217,000, according to the Medicare Payment Advisory Commission. That year, the commission expected penalties to total about $556 million — 0.3% of hospitals’ overall Medicare payments.
Hospital-related injuries and illnesses
The federal government reduces Medicare payments by 1% for hospitals that rank in the worst-performing 25% in measures of hospital-related injuries and infections.
To assess hospital performance, the Hospital-Acquired Condition Reduction Program analyzes the frequency of five types of infections, including antibiotic-resistant infections, and 10 types of in-hospital injuries, like hip fractures, blood clots and bedsores. As with the Hospital Readmission Reduction Program, certain hospitals — including psychiatric and children’s hospitals — are exempt.
In Minnesota, 11 of the state’s 48 nonexempt hospitals were penalized in fiscal year 2021. That includes several hospitals penalized in at least four of the past seven years: University of Minnesota Medical Center Fairview, Carris Health in Willmar, Hennepin County Medical Center and Fairview Northland Regional Hospital in Princeton.
States hardest hit by penalties in 2021 include Alaska (six of eight hospitals penalized), Nevada (14 of 23) and Rhode Island (six of 10).
Just three Minnesota hospitals — Mayo in Rochester, Northfield Hospital and Essentia Health St. Mary’s in Duluth — have not been penalized for hospital-related injuries and infections in the past seven years.
Hospitals that treat high proportions of low-income patients and especially medically fragile patients, along with teaching hospitals, tend to be punished more for hospital-acquired conditions, NPR reported in 2018.
Some hospitals say facilities that track illnesses and injuries the most carefully bear the brunt of the penalties, however, and the American Hospital Association has criticized the program as flawed and ineffective.
Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our web site. Please see our republishing guidelines for use of photos and graphics.