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Local Hospitals Penalized for Readmission Rates

Health

Baylor Scott & White Medical Center | Image by NBC DFW

Three North Texas hospitals have been penalized by the federal government for their high readmission rates.

Baylor Scott & White Medical Center Uptown (Dallas), Baylor Scott & White Surgical Hospital (Fort Worth), and Methodist Hospital for Surgery (Addison) will lose up to 3% in Medicare payments as a penalty for their high level of patient readmissions within 30 days of initial care.

In 2012, the Affordable Care Act introduced readmission rate tracking and Medicare penalties to encourage better healthcare service.

The three DFW-area hospitals receiving the penalty were confirmed by a spokesperson with the Centers for Medicare and Medicaid Services (CMS).

Kaiser Health News (KHN) has been tracking government data on hospital readmissions, which can be very difficult on patients and expensive for taxpayers.

The penalty reduces the amount the hospitals receive as payment for every Medicare or Medicaid patient for the entire fiscal year, October 2022 through September 2023. The penalty is substantial since hospitals frequently complain that present Medicare payments are too small in the first place, according to KHN.

CMS divides facilities into five categories, allowing for an appropriate comparison among similar hospitals. CMS also excluded from its calculation Medicare patients who were readmitted with pneumonia. This was due to the difficulty distinguishing these patients from those with COVID-19.

Akin Demehin, senior director of quality and patient safety policy at the American Hospital Association, said these changes were warranted.

“The COVID pandemic did a lot of really unprecedented things to care patterns of hospitals,” he said.

“COVID has been a tremendously disruptive force for all aspects of health care, most certainly CMS’ quality measurement programs,” Demehin added. “It’s probably going to be a couple of volatile years for readmission penalties.”

According to KHN, year-to-year variations in the pool of patients, the doctor performing a procedure, and the general reputation of a facility can also alter results.

The hospital system that owns two of the offending North Texas hospitals, Baylor Scott & White, recently came under scrutiny after Raynaldo Ortiz, an anesthesiologist who worked at the Baylor Scott & White Surgicare in North Dallas, allegedly spiked IV bags with nerve-blocking agents and induced medical emergencies in several patients at the facility.

The facility shut down for some weeks following revelations about Ortiz’s alleged criminal activity. Federal agents arrested Ortiz in September. He is currently awaiting trial for multiple felony charges.

A spokesperson for Baylor Scott & White explained back then that “the [Department of Justice] noted that investigators believe the problem was limited to one individual who has been arrested and is in custody.”

Commenting on the recent Medicare penalty two of its facilities received, Baylor Scott & White said in an email to NBC 5, “These two surgical hospitals have been recognized for high-quality patient care by various sources, including US News & World Report. It is important to note that readmissions not related to the surgical procedure performed are included in this calculation.”

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