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Nursing homes dinged over Medicare readmissions
Northeast Mississippi Daily Journal - 12/16/2018
Dec. 16--TUPELO -- The Medicare readmission penalties facing hospitals have caught up with nursing homes.
For 2019, nursing homes caring for Medicare patients will receive penalties or bonuses based on how well they met targets to reduce avoidable hospital readmissions. At the regional, state and national levels, far more nursing homes will see a penalty than a bonus.
Fee-for-service Medicare doesn't pay for long-term nursing home care, but it does cover up to 100 days of skilled nursing care after a hospitalization. Not every nursing home in Mississippi offers this kind of short-term care.
To determine the incentives, the Centers for Medicare and Medicaid looked specifically at Medicare patients who were readmitted to the hospital within 30 days of a nursing home or skilled nursing center stay between 2015 and 2017.
In Mississippi, 85 percent of the 201 nursing homes receiving Medicare reimbursements will face reductions for too many hospital readmissions, based on Kaiser Health News analysis of the Medicare data.
In Northeast Mississippi, 25 out of 37 nursing homes and hospital skilled nursing units -- 68 percent -- will face a reduction between .07 percent and 1.98 percent in the reimbursement they received for Medicare patients in 2019.
Nationally, 11,000 nursing homes will see lower payments; nearly 4,000 will receive bonuses for readmission, the Kaiser Health News analysis found.
In Northeast Mississippi, the readmission penalties do not correlate with the overall quality ratings that nursing homes receive from the Centers for Medicare and Medicaid'sNursing Home Compare.
Of the 15 Northeast Mississippi nursing homes and skilled nursing units that will see reductions between 1.9 percent and 1.98 percent -- the highest penalty assessed in -- only three are rated below average by Nursing Home Compare.
Of the 12 receiving bonuses between .02 percent and 1.65 percent, three rated below average or worse.
"This is just one quality measure," said Alan Brown, chief operations officer for Mississippi Methodist Senior Services, parent company for Tupelo'sTraceway.
Cedars Health Center on the Traceway campus will see nearly a 2-percent penalty on readmissions, but has the highest quality rating -- five stars or much above average -- given on Nursing Home Compare, which is compiled by CMS.
The readmission penalty will cost Cedars an estimated $75,000 next year, Brown said.
Nursing homes have traditionally erred on the side of caution, sending patients to the hospital for a higher level of care, Brown said. There have been significant adjustments since 2017.
"Our numbers are actually trending down," Brown said. "The system is evolving."
Partnerships with North Mississippi Medical Center-Tupelo and the NMMC Family Medicine Residency Center have brought more physicians to Cedars and the Traceway campus, Brown said. This fall, Cedars started a new program where patients have an option for a nurse practitioner to visit them in the first three days they are home, checking on medications, making sure follow-up appointments are set and evaluating any needs they have.
Bigger changes are coming as Medicare moves to a patient-driven payment model next year, Brown said.
"Basically we're adopting to a whole new payment model," Brown said. "This is the biggest change in over 20 years."
More online: Visit DJournal.com to see a chart of the bonuses and penalties for Northeast Mississippi nursing homes and hospital skilled nursing centers.
(c)2018 the Northeast Mississippi Daily Journal (Tupelo, Miss.)
Visit the Northeast Mississippi Daily Journal (Tupelo, Miss.) at www.djournal.com
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