Too Many Returning Patients | Video

Michelle San Miguel | 9/27/2012

Sick patients hope their hospital stay is short: in and then home. But with some types of illness, readmission rates are high, this is particularly true for heart failure patients.

Starting next week, hospitals with high readmission rates will start losing some of their Medicare reimbursements. One of them is Sanford Medical Center here in Bismarck. The penalty stems from the Affordable Care Act. Medicare says nationwide nearly one in five patients is readmitted to the hospital within a month of being discharged and Medicare says that`s simply too high.

No one likes to stay at the hospital overnight, much less come back often, but patients who suffer from heart failure account for some of Sanford Medical Center`s highest readmission rates.

"They don`t have resources to get the medications or the care they need or they just opt not to. They get sick again, they come back in the ER, then they end up admitted for a few more days again, they go back home and it`s just a vicious cycle," said Vice President of Clinical Quality Evy Olson.

Over the next year the hospital will lose about $100,000 in Medicare reimbursement. It`s a small slice in the pie, but Medicare says the intent is not just to penalize.

Mike Fierberg- not to extract from hospital reimbursements but to have hospitals provide the highest possible quality of care so that they`re aren`t as many readmissions which tend to be exceedingly expensive," said Public Affairs Specialist for Centers for Medicare & Medicaid Services Mike Fierberg.

Between 2009 and 2010, 30 percent of the hospital`s heart failure patients were readmitted within a month of being discharged. The following year 19 percent were readmitted in that same time frame.

"These people are on a lot of medicines. I mean just for heart failure themselves they can be on five medicines and then a lot of them have other problems," said Heart Failure Program Director Dr. Walter Frank.

Medicare says patients who can`t afford their medications should apply for Medicare`s Extra Help program.

"People who qualify typically don`t pay anything for their part D insurance and can get their medications regardless of how expensive they are in retail for a co-payment typically of $6.50 a month or less," Fierberg said.

In the end, ability to pay doesn`t determine who is admitted.

"If they are failing and that is how they are managing their life and they come to our emergency department, we are gonna admit them whether we have a readmission penalty or not," Olson said.

But, she says the penalty has pushed them to evaluate their readmissions and try to lower those numbers.

It`s important to note that Medicare was looking at readmission rates from as far back as 2008 when it was calculating the penalty. Sanford has since started a program specifically for its heart failure patients and improved its readmission rate.

We will have more on that program tomorrow.

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