Neither the McPherson Hospital or Newton Medical Center was designed with revolving doors at the entrances, a metaphor for the goal of the hospital — and how to avoid Medicare penalties resulting from the Affordable Care Act.

"The objective of these penalties is obviously designed to reduce the number of readmissions and hospital-acquired conditions, which in turn reduces the amount of reimbursement from Medicare," said Cyril Russel, director of marketing for McPherson Hopsital. "This is good for patient care because hospitals focus efforts on reducing these incidents. We, as most hospitals across Kansas, have been affected financially in one way or another by these reimbursement reductions."

Under programs set up by the Affordable Care Act, the federal government cuts payments to hospitals that have high rates of readmissions and those with the highest numbers of infections and patient injuries. For the readmission penalties, Medicare cuts as much as 3% for each patient, although the average is generally much lower. The patient safety penalties cost hospitals 1% of Medicare payments over the federal fiscal year, which runs from October through September.

Since 2012, Medicare has punished hospitals for having too many patients who end up back in their care within a month. According to Kaiser Health News, the hospital industry lost $566 million in 2018 to penalties that will stretch over the 12 months. The penalties are a signature part of the Affordable Care Act’s effort to encourage better care.

“The percentages range quite a bit,” said Cindy Samuelson, vice president, member and public relations of the Kansas Hospital Association. “Some are as small as .01%. ... We have not collected the data as far as dollar amounts.”

According to the database, 38 hospitals — out of 123 community hospitals in Kansas — have been under the readmission penalty at least once in the last five years. Of those, 22 have been under penalty every year for the last five years. McPherson Hospital has been one of those, facing penalties ranging from .10 to .38% during a six-year stretch.

"There is opportunity to improve practices and processes which lead to better health outcomes for our patients," Russell said. "Among other initiatives, we have created a process improvement task force that focuses on early identification of potential cases. We also know the importance of infection control so we have increased hand hygiene efforts by building awareness, maintaining good practice standards, tracking activity and communicating results throughout the facility. In addition, we collaborate with local nursing homes to improve care following discharge to lessen the potential for readmission. These initiatives, among others, are focused on decreasing these types of cases, and we are committed to upholding our high standards of care."

Newton Medical Center is not currently under penalty for hospital-acquired conditions, though is will be under a .03% penalty for hospital admissions in 2020. According to a searchable database from Kaiser Health News, Newton was subject to a .08% penalty for 2019 and a .06% penalty in 2018. Newton has faced a readmission penalty in three of the last five years.

Porter said anyone with an inpatient stay at Newton Medical Center, then are readmitted to the hospital within 30 days, they become part of the readmission percentage.

“We actually have benchmark performance on readmission,” said Heather Porter, a chief clinical officer at Newton Medical Center. “Our percentage is so low. Their average is about .71%, and we are at .03% in comparison ... With the Affordable Care Act, medicine really transitioned to value-based purchasing which means the program penalizes — or incentivizes — hospitals based on their quality outcomes. Readmission is one of these outcomes they grade on.”

Kaiser Health News has made available a searchable database of penalties at https://khn.org/news/hospital-penalties/.

Seven hospitals in Kansas have faced a penalty for hospital-acquired conditions. McPherson Hospital has been on that list for two consecutive years — the 2020 penalties for hospital-acquired conditions is not yet available.

“There was education done in advance of this so that hospitals would understand that there would reductions based on excess rehospitalizations and these areas,” Samuelson said. “CMS’ overarching goal is reducing readmissions. That is going to improve quality and reduce spending. We all know that some readmissions that happen are hard to control.”

She mentioned economic status, insurance status and other factors that are “outside the control of the hospital.”

According to Kaiser Health News, 800 hospitals were paid less by Medicare in 2019 because of high rates of infections and patient injuries. In Kansas, hospitals have started working together to find ways to improve care and reduce medicare penalties.

“The goal would be zero, obviously. They are striving for this,” Samuelson said. “There are some small percentages in there that they may not be able to really address ... There are some numbers that are higher and those hospitals are working strategies to look at what is behind those numbers to see, case by case, how they can improve quality.”

They are not working alone.

In 2008 the Kansas Healthcare Collaborative was formed — and out of that came the Hospital Improvement Innovation Network. According to a four-page report by the Kansas Healthcare Collaborative, there are 118 member hospitals in the HIIN. Both Newton and McPherson are in that network. Other hospitals in the region in the network are located in Hutchinson, Marion, Hillsboro, Marion and El Dorado. According to the Kansas Hospital Association, per capita Kansas has the second-largest network of hospitals dedicated to quality improvement work — the largest is Texas.

According to the report, member hospitals have prevented 3,549 harms, saved 295 lives and $34.9 million since 2016 by reducing opioid drug events, surgical infections, catheter associated UTIs, C-diff infections, ventilator associated conditions, surgical site infections and sepsis mortality.

“It is very exciting to see the change that has been happening in these hospital initiatives to improve the quality of care and reduce readmissions,” Samuelson said. “A lot of change has happened in our state in the very recent history.”