CHCC readmissions below national average—Muña

The Commonwealth Health Center’s statistic on readmissions has remained steady below the national average, according to Commonwealth Healthcare Corp. CEO Esther Muña.

Muna

This helps the CNMI’s lone public hospital avoid fines from the Centers for Medicare and Medicaid Services so it doesn’t lose funds, Muña said.

She noted that throughout fiscal year 2014 (October 2013 to September 2014), compliance with CMS regulations has improved and that is evident in the survey conducted on Sept. 29, 2014.

As of September of last year, the hospital’s readmission rate was at about 13.6 percent, much less than the national average of 20 percent.

CMS Medicare program fines any hospital that has high readmission rates. For example, if Medicare normally pays a hospital $15,000 for a kidney failure patient, a 1.5 percent penalty means Medicare would deduct $225 and pay just $14,775.

“The conditions that yield penalty for readmissions are for heart failure, heart attack, pneumonia, and chronic lung problems. Penalties are up to 3 percent and are calculated by Medicare contractors,” Muña said.

The penalty does not apply to other Medicare payments for a hospital’s general operating expenses, training of medical residents, or treatment of large numbers of low-income patients.

For penalized hospitals, CMS will reduce each payment for a patient stay from October 2014 through September 2015, which is the federal fiscal year.

CHC has remained at a steady pace compared to 2013 where its readmission rate was usually above 18 percent and even higher.

CMS made these laws so that hospitals would take care of its patients effectively and remaining steady helps with the reimbursement it receives from Medicare and Medicaid reimbursement.

“Most of the readmissions we see are because patients have not properly managed their diseases—they stopped their medications and haven’t followed up with their doctor. This is why we have been accelerating our campaign for our residents to visit their doctor regularly, take their medication, and live an active and healthy life. Reopening the Internal Medicine clinic helps as well,” Muña said.

CHCC has also been recognized with a “Pursuit of Excellence Certificate” from Mountain Pacific (Medicare Quality Improvement Organization) for maintaining lower admission rates.

CHCC’s Corporate Quality and Performance Management department provides for the implementation and advancement of the hospital’s programmatic requirements.

“All programs within CQPM for the hospital that includes infection control, utilization review/discharge planning, and quality management are continuously maintaining its programmatic efforts, as well as making significant progress toward meeting CMS’ conditions of participations,” Muña said.

“CQPM also coordinates the utilization review and discharge planning program. In fiscal year 2014, the program continued to monitor all hospital admissions for appropriateness. This initiative ensures that all admissions fall under a medical necessity as defined by best practice criteria and that the quality of care is delivered based on the standard of care and its medical necessity and that the services are reimbursable per CMS,” she added.