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Providence hospital fined for too many readmissions

Providence Medford Medical Center [Jamie Lusch / Mail Tribune]

Providence Medford Medical Center is being penalized by Medicare for having too many patients readmitted to the hospital; Asante’s three local hospitals are not being fined.

Medicare can cut payments by up to 3%. In 2023, Providence Medford Medical Center will have a readmission penalty of 0.31% based on its performance over the past few years. The hospital has a history of repeated Medicare penalties.

Asante Ashland Community Hospital, Asante Rogue Regional Medical Center in Medford and Asante Three Rivers Medical Center in Grants Pass all have a history of scattered fines. In recent years they’ve all improved their performance and avoided fines, including for 2023.

The nationwide Hospital Readmissions Reduction Program lowers future Medicare payments to hospitals if more patients than expected are readmitted within 30 days of discharge. The program tracks readmissions among Medicare patients who’ve had heart failure, heart attacks, chronic obstructive pulmonary disease (COPD), coronary artery bypass grafts and knee and hip replacements.

Asante and Providence said they’ve taken a number of steps to help patients so they don’t wind up back in the hospital.

Asante has a team that meets weekly to review readmissions, said Holly Nickerson, a registered nurse and vice president of quality and patient safety for Asante.

Some patients need help taking care of themselves after they leave the hospital.

“We know that it’s not a one-size-fits-all for every single patient. So sometimes we do very individualized interventions to support someone transitioning out of the acute care setting into a home setting,” Nickerson said.

Help can come in the way of getting people rides to follow-up appointments, setting them up with Meals on Wheels home-delivered food or discharging hospital patients to skilled nursing facilities. A broad range of people help address patients’ needs, including nurse navigators and social workers, Nickerson said.

She said the team that analyzes individual readmission cases also looks for broader trends that could be signs of trouble.

“So if we were to see a week where we had a lot of readmissions for one specific diagnosis, we would take a deeper dive and say, ‘Hey, what’s going on specifically with that diagnosis?’” she said.

For example, Asante was seeing issues with heart failure patients after they had been discharged. It focused more attention on helping those patients transition successfully from the hospital to outpatient settings, Nickerson said.

Heart failure is particularly challenging because patients often have other medical problems, such as diabetes, high blood pressure or lung disease, she said.

Asante said it helps patients with a range of heart problems through its cardiac rehabilitation gym at RRMC. Patients do exercises that aid their recovery by improving cardiovascular fitness, strength, balance and flexibility.

Nickerson said Medicare penalties for readmissions aren’t always fair.

“It can feel challenging when you have a patient who was discharged home from pneumonia and they got into a car accident three weeks later and come back to the hospital. But those cases happen very little,” she said.

Overall, she said the nationwide tracking of readmission data can improve patient care and reduce health care costs. The tracking program also takes into account that not all readmissions are avoidable.

Nickerson said the penalties don’t stop Asante health care providers from readmitting patients to the hospital if that’s the care they need.

“That’s something that never even crosses our mind,” she said.

Nickerson said patients and their families can do their own part to lower the risk of readmission.

If possible, patients should have a friend or family member present to listen to discharge instructions, ask questions, write notes and serve as an advocate, she advised.

“We recognize that it’s very challenging. You don’t feel good, you’re in the hospital and right before you leave, someone’s having a conversation with you about all your medications and going to your follow-up appointments and doing all the things you have to do in your home setting,” Nickerson said.

Having a friend or family member be a second set of ears is invaluable, she said.

Correction: This article has been updated with the correct sources of information from Providence.

Dr. Jason Kuhl, chief medical officer for Providence Medford Medical Center, said most of its readmission penalties are related to heart failure and COPD. Both are chronic conditions that get worse over time and can be impacted by age, other health conditions, diet, substance use, tobacco use and socioeconomic status.

Kuhl said the hospital has taken many steps to reduce readmissions. It’s increased patient and family education about chronic disease management and the importance of complying with dietary restrictions, avoiding tobacco and harmful substances, taking medications as directed, following up with their doctors on a regular basis and watching for warning signs a condition is getting worse.

Providence created a nurse navigator team to help patients transition back to their home or a care facility after being discharged. There’s a nurse call center to follow up with patients within 48 hours of discharge to answer any questions they have, Kuhl said.

He said the hospital boosted its case management and social worker services to help connect patients to resources in the community, like home health services, in-home physical therapy, mental health care, food, transportation and housing. It also launched an outreach program to help vulnerable, underserved community members.

Providence Medford Medical Center doesn’t let the threat of Medicare penalties stop it from readmitting patients, Kuhl said.

“While Providence Medford has taken numerous steps to lower readmission rates, it is extremely important to know that we do not avoid admitting any patient whose admission is deemed medically necessary,” he said. “We continue to encourage patients to seek medical care when they are not feeling well, regardless of whether they have recently been discharged from our facility.”

Kuhl said the Medicare Payment Advisory Committee estimates only 12% of readmissions are avoidable and 88% are unavoidable.

He said controversy remains about whether readmissions reflect the quality of care patients received during their initial stay at a hospital, or if they reflect external factors like age, homelessness, a shortage of beds at nursing homes or a lack of access to community services, primary care or home health services.

Nationwide, 93% of hospitals subject to the Hospital Readmissions Reduction Program have been penalized, and most have been penalized multiple years, Kuhl said.

He said hospital readmissions have gone down nationally since the program started almost a decade ago, but hospitals have limited — if any — ability to directly influence readmissions.

Models that try to predict which patients are most at risk for readmission are unreliable, which makes it hard for hospitals to target at-risk patients and offer extra help, Kuhl said.

He said research has shown hospitals that serve more vulnerable patients are at the highest risk of being penalized. That could take away resources from those hospitals, leading to higher readmission rates.

In addition to having Medicare payments reduced by up to 3% for too many readmissions, hospitals could also lose 1% for too many hospital-acquired conditions like infections, falls that cause harm and bed sores.

Asante hospitals in Medford and Grants Pass have yearslong track records of avoiding penalties for hospital-acquired conditions.

Asante Ashland Community Hospital was penalized from 2015-19, but has had no penalties since then.

Nickerson said the Ashland hospital used to average only 12 patients daily. Its hospital-acquired conditions rate could swing widely because of one infection. The hospital is now more fully used in the Asante system and averages 22 patients daily.

The Ashland hospital has also improved its processes and has more staffing, Nickerson said.

Nickerson said the Asante system as a whole has teams that investigate infections and other issues. Nurses and other health care providers follow a set of practices that reduce risk.

For example, using a catheter to empty a patient’s bladder comes with the risk of urinary tract infections. Health care workers are taught to use a catheter for the minimal amount of time necessary, Nickerson said.

Providence Medford Medical Center was penalized in 2015 and 2016 for hospital-acquired conditions, but has avoided penalties since then.

“At Providence Medford, these areas have been subject to continuous improvement efforts with a goal to reduce and prevent such events,” hospital’s infection prevention team said in a written response.

Providence said it uses multidisciplinary teams to analyze data and make improvements.

Advancements in electronic medical records systems mean hospital infectious disease and infection prevention professionals can quickly identify potential concerns. The systems help identify risk factors for problems like surgery site infections and urinary tract infections related to catheter use, the infection prevention team said.

“A culture of safety is encouraged and celebrated at Providence Medford. Our leaders regularly recognize caregivers who champion safety,” the team said.

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.

Amy Eaton, exercise specialist, and Carson Meyers, supervisor, demonstrate some of the exercises that aid in heart patients’ recovery at the cardiac rehabilitation gym at Asante Rogue Regional Medical Center. [Photo courtesy of Asante]