Wednesday, August 31, 2016

Only One New Jersey Hospital Not Penalized by CMS for Medicare Reimbursement

The Center for Medicare & Medicaid (CMS) engages in a Hospital Readmission Reduction Program that aims to penalize any hospital if they have a higher readmission rate than determined in the year 2017. They do so by withholding Medicare reimbursements.

Only one hospital in New Jersey did not receive a penalty, and that hospital was Hunderton Medical Center.

hunderton medical center

CMS compares actual readmission rates with expected rates based on patient risk factors for five conditions including: acute myocardial infarction (heart attack), congestive heart failure, pneumonia, chronic obstructive pulmonary disease, and total joint replacements. If the actual readmission rate exceeds the expected rate, the hospital receives a reduction in their Medicare reimbursement for the next year.


Fines were determined based on data for the period from July 2012 to June 2015. Each hospital was assessed by what their reported readmission rate was and what CMS determined to be an appropriate rate based on national and demographic information.


“Hunterdon Medical Center has been analyzing our readmission rates and implementing measures to improve them for many years. Once discharged from the hospital, patients are followed up by a specialist or primary care physician within three to five days after being released from the hospital. In fact, we are now making these appointments for our patients while he/she is still in the hospital,” explained Robert Coates, M.D., Vice President of Medical Affairs.

Read full article.

Technology seems to be on their side as Hunderton has been using more advanced software to try and determine which patients might be at a higher risk for readmission so that they can be cared for more closely. If you think about it, this is a very smart way of predicting what patients might have a more severe health problem that needs to be dealt with now rather than later. Should more hospitals adopt this strategy?

Interestingly enough, technology has had another major influence in the way doctors are examining patients and then collecting on Medicare procedures.

Technology Influences Medicare from the Doctor’s Office

In Woodbridge, NJ, Robert Boyd uses a new medical device to perform an evaluation in his office rather than referring to another doctor or specialist. He began using this device to test for a specific neurological condition:

He used a device to test whether people sweat in response to a low-voltage current, a way to diagnose nerve damage. In 2014, he collected $105,905 from Medicare for the procedures.

Testing for the condition rose nationwide in recent years after a device became available that allows doctors to perform tests in their offices—and to make more profit from Medicare for doing so. The federal program for seniors and disabled people paid out $16.7 million for the test in 2014, according to the latest data, a 10-fold increase from two years earlier.


Such increases are commonplace after the introduction of medical devices that allow doctors to provide services in their offices that they used to refer elsewhere. A Wall Street Journal analysis of recently released Medicare billing data showed that four of the top 10 fastest-growing Medicare services from 2012 to 2014 involved new devices.


Medicare’s tab for those four services rose by $123.5 million from 2012 to 2014, to $135 million, the data show. In each case, a small cadre of doctors adopted the services much faster than their peers. Less than 10% of doctors accounted for more than half the rise in spending for each service, the Journal found. The Journal studied only services performed throughout that period with at least $5 million in 2014 payments.

Read more at the WSJ.

As time moves on, technology is influencing our culture at a rapid pace. Doctors are now given more choices which can help them make better decisions in the office without spending more time or delaying an evaluation by sending the patient to another appointment. Will this have a greater influence on Medicare in New Jersey? Only time will tell.

The 2017 Medicare enrollment period is approaching and seniors should begin to consider looking at their NJ Medicare Plans in order to make the right decision moving into the new year. Insurance brokers can assist with this decision as it can be a confusing and complex level of detail to navigate. Some providers like Aetna are leaving the healthcare marketplace, which means your Medicare Advantage plan could be affected.

Need help during the upcoming enrollment period?

Your Recommended Agent is Greg from BGA Insurance Group

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Greg Gudis – Licensed agent ready to assist you during the enrollment period in October 2016. Please fill out the form below to send your information to Greg so that he can contact you with the best advice and plan information for your current situation. He can also provide expert advice on retirement planning, life insurance, and long-term care.

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The post Only One New Jersey Hospital Not Penalized by CMS for Medicare Reimbursement originally appeared on The Aging Adult Guide

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