LRGH subject to small Medicaid reimbursement penalty for readmission rate considered to be too high

LACONIA — Lakes Region General Hospital was among nine hospitals in New Hampshire penalized by the Center for Medicare and Medicaid Services for what are considered excessive readmission rates.

The penalty, introduced in 2012 by the Affordable Care Act, is intended to prod hospitals into ensuring that when they discharge patients they will not need to return in order to eliminate unnecessary care and curb Medicare expenditures. A formula is applied to calculate the penalty, which amounts to a reduction in Medicare's payment for every patient of up to three-percent.

Lakes Region General Hospital was not penalized in the first two years of the program, but this year incurred a penalty of 0.22 percent the fourth lowest levied against the nine hospitals, which will reduce its Medicare payments to 99.78 on the dollar in 2015. With total Medicare payments in the neighborhood of $18 million, the penalty represents a loss of revenue of less than $40,000.

In a prepared statement, Gloria Thornington, director of medical safety and health management at LRGHealthcare, said the corporation is "proud of the record we've had with keeping readmissions to the hospital at a minimum." Since the standards were introduced she said that the hospital pursued "Better Outcomes by Optimizing Safe Transitions" (BOOST) and "Almost Home", programs aimed at minimizing the likelihood of readmission and preparing patients to manage their care.

Thrnington said that "for many of our diagnoses, our readmission rate has consistently been amongst the lowest, putting us in the top 10 percent of hospitals in the Unied States." She said that when patients are discharged, they receive a follow-up call within 48 hours and an appointment with their primary care provider within seven days. "This year's data," she said, "reflects new measures and we see this as a great opportunity to learn where we can improve upon our programs and continue to keep readmissions at a minimum."

The standards have been criticized for failing to adequately adjust for those hospitals, like Lakes Region General Hospital, that serve a disproportionate number of patients enrolled in Medicaid and receiving Supplemental Security Income (SSI), who studies show have relatively high readmission rates.