8 Investigates: Patients still sick, hospitals lose money

JONESBORO, AR (KAIT) - When it comes to patients readmitted back into the hospital for the same symptoms, we found many Arkansas hospitals get a failing grade.

Now, Medicare is demanding improvements and hitting hospitals where it hurts. The federal health insurance program is fining hospitals if patients continue to come back with the same problem.

The government says it's a national problem.  But one local man says it will take more than just the medical community stepping up to fix the problem.

"I don't really care about your boundaries.  I just want the best care I can get for my wife," said Craig Jones.  He has dealt with his fair share of hospital visits.  Jones is the caregiver for his wife, who deals with an ongoing health condition.

"They need to provide me with information that I need and to educate me to deal with me wife.  I've learned to be a little, well, pushy at times," said Jones.

Because of his experiences, Jones is now working with the Arkansas Care Transitions East Coalition to help improve health care and patient outcomes.

"Given the economics of Arkansas and the past way in which we've done health insurance, it's not surprising to see a large number of people needing to be re-admitted," said Jones.

A recent report from Kaiser Health News found 82% of the hospitals in the Arkansas received penalties from Medicare for having a large number of hospital readmissions.  Eleven of those hospitals are in Region 8.

Five Rivers Medical Center in Pocahontas received the maximum penalty.  CEO Luther Lewis is well aware of the problem.  "It's affected us at the tune of about $20,000."

According to the report, Fiver Rivers Medical Center was one of only 18 hospitals in the United States to receive the maximum fines.  "There was one year in 2011 where our readmission rate was extremely high and as long as that year is in this rolling average, I think we'll be at a higher penalty," said Lewis.

According to Lewis, the penalties are based on a rolling three year average and impact the annual hospital budget.  "When you find out you're being reduced, all you can do is turn around and reduce your expenses," said Lewis.

In the past two years, hospital officials at Fiver Rivers Medical Center have reduced their staff by about 30 full time employees.  Right now, Lewis says the main goal is to improve post-hospital care.  "Making sure they have adequate care at home or having home health visits.  It may mean the patient maybe needs to go to a skilled nursing facility for a few weeks," said Lewis.

Lewis says it is important that nurses and case managers work to make sure the patients are released to a proper environment for recovery.

Craig Jones seconds that notion, "Every successful transition begins and ends with me and I need to know how to help the medical community to give my wife the best care possible."

The Medicare penalty program started in 2012.  Since that time, Jones has noticed medical staff putting more of a focus on his wife's post-hospital care.  "Four years ago, you would check out, they would ride you to your car and when you get up from that wheelchair, their responsibility ends. Now, if my wife comes out of an institution, within 24 to 48 hours, there's a follow up call.  How are things going? Were you able to get your medications?"

But while Jones says the ACT Coalition and Medicare are making strides, he worries about how the penalties could impact rural hospitals.

"They're operating on very; very small profit margins and the federal penalties could conceivably put some of them out of business within the next decade," said Jones.

Jones says the coalition hopes to drop the readmission rate by at least 20%.  But to do that, he says it will take an effort from the entire community.

To learn more about the Arkansas Care Transitions East Coalition, go to https://www.facebook.com/ArkansasCareTransitions/info

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