New Jersey has the nation’s highest percentage of hospitals having their Medicare reimbursements reduced because they failed to meet Affordable Care Act targets for reducing the number of patients readmitted after treatment.
New Jersey’s dubious distinction is included in a state-by-state list contained in a report by Kaiser Health News.
The penalties, which are capped at 3 percent for this fiscal year, are being levied for the third year under the ACA. The penalties are being phased in. The maximum penalty was 1 percent in FY 2012-13 and 2 percent in FY 2013-14.
The only hospital in New Jersey that isn’t being penalized this year, HackensackUMC at Pascack Valley, didn’t have a full set of discharge data because it only recently reopened. The penalties are based on a three-year rolling timeframe, with a new set of penalties that went into effect on Oct. 1, based on data from July 1, 2010, to June 30, 2013.
New Jersey hospitals that serve predominantly lower-income residents, who are more likely to have complex, chronic health problems, top the list of those that will see the largest federal penalties.
No New Jersey hospitals are among the 39 nationally that will receive the maximum penalty of 3 percent.
The penalties were put into place as part of the 2010 Affordable Care Act in order to hold hospitals responsible for the quality of information that patients receive when they are discharged, as well as for coordinating the follow-up care that patients receive. It’s a stark change from previous years, when hospitals could actually receive more money for readmissions.
The penalty is based on a formula that seeks to define excessive readmissions for each of five types of procedures, with hip and knee replacements and chronic lung disease added this year, joining heart failure, heart attacks and pneumonia on the list.
The penalties will now be applied to all Medicare inpatient stays for the coming year, not just readmissions. For instance, if a hospital had a high number of readmissions for the five conditions tracked by the federal government, it will be penalized for all of its Medicare payments, including for treatments for illnesses like cancer, and not just for the five conditions being tracked.)
Critics of the penalties have said that they unfairly single out so-called safety-net hospitals, since low-income residents are more likely to have complex, chronic conditions and face greater barriers to receiving primary care. Defenders of the penalties say that while additional resources should be devoted to safety-net hospitals, the penalties remain a useful accountability measure.
Palisades Medical Center, which recently announced that it is becoming a part of the larger Hackensack University Health Network, will see the largest reduction in its Medicare inpatient payments, at 2.65 percent.
Here is the list of hospitals and the percent they are being penalized, as well as some of the conditions that were particularly problematic for each hospital:
1. Palisades Medical Center, North Bergen, 2.65 percent
Palisades had the highest rate of excessive readmissions in the state for patients with heart failure; the second-highest for those with chronic obstructive pulmonary disease (COPD), a type of lung disease; and ranked fifth-highest for pneumonia and sixth-highest for heart-attack patients.
2. St. Joseph’s Regional Medical Center, Paterson, 2.24 percent
St. Joe’s had the second-highest rate of excessive readmissions for heart failure; it was fourth-highest for COPD; fifth-highest for heart attacks; and eighth-highest for hip and knee replacements.
3. CarePoint Health-Christ Hospital, Jersey City, 1.93 percent
Christ Hospital had the second-highest number of excessive readmissions for pneumonia; it was third-highest for COPD; fourth-highest for heart failure, and eighth-highest for heart attacks.
4. Kennedy University Hospital – Stratford, 1.78 percent
The only South Jersey hospital on this list, Kennedy had the fourth-highest rate of excessive readmissions for pneumonia and the fifth-highest for heart failure.
5. Capital Health Medical Center – Hopewell, 1.74 percent
Capital Health had the second-highest rate of excessive readmissions for hip and knee replacements.
6. Saint Michael’s Medical Center, Newark, 1.71 percent
Saint Michael’s had the second-highest rate of excessive heart attack readmissions, It had the third-highest rate for hip/knee replacements and the eighth-highest rate for heart failure.
7. LibertyHealth-Jersey City Medical Center, 1.54 percent
Jersey City, which is joining Barnabas Health, had the sixth-highest rate of excessive readmissions for heart failure; it was seventh-highest for heart attacks and ninth-highest for COPD.
8. Saint Peter’s University Hospital, New Brunswick, 1.34 percent
Saint Peter’s was sixth-highest in excessive pneumonia readmissions.
9. Valley Hospital, Ridgewood, 1.31 percent
Valley had the seventh-highest rate for excessive readmissions of heart-failure patients.
10. Meadowlands Hospital Medical Center, Secaucus, 1.28 percent
Meadowlands was ninth-highest for rates of both pneumonia and heart-failure readmissions.