Hospital Challenges CMS Penalty Program

Officials of the Beaufort Memorial Hospital, located between Charleston and Savannah, got some disquieting news. They learned that their hospital would be penalized for hospital readmission rates that were higher than the national average from July 2012 through June 2015.

The government’s Hospital Readmissions Reduction Program requires Centers for Medicare and Medicaid Services (CMS) to track readmissions of Medicare patients within 30 days of their discharge for six medical criteria.

Beaufort Memorial was below the readmission rate for four of the six criteria. It was only in the last two conditions—hip and knee replacements—that the hospital was noticeably above the average.

It is significant to note that under the Hospital Readmissions Reduction Program, the readmission of a Medicare patient who was originally hospitalized for one of the six conditions to any hospital for any other condition is considered a readmission to the original hospital.

Kurt Gambla, vice president and chief medical officer of Beaufort Memorial Hospital, (who leaped to his hospital’s defense) noted that a patient who received a knee replacement at Beaufort Memorial on March 3 and was involved in a car accident at Jacksonville on March 24 and was admitted to a hospital there, was counted as a Beaufort Memorial readmission.

Gambla maintains that readmission should not be confused with poor outcomes. He said that, in readmitting patients, the doctors at Beaufort Memorial were operating from “an abundance of caution.”

The joint replacement center, he points out, has a high patient satisfaction rate. Patients leave the hospital with a list of numbers to call day or night with any concerns they may have. Patients receive a check-up call from the hospital within 24 hours and see their surgeon for a followup within 24 to 48 hours. Gambla reports that, for 2015, the hospital’s readmission rates were well below the national average.