story by Alex Nussbaum, with Bloomberg News, and The City Wire staff
Community Health Systems Inc. and LifePoint Hospitals Inc. face the biggest reductions in payments next month when the U.S. Medicare program starts penalizing providers with high readmission rates, according to an analysis of government data by CRT Capital Group LLC.
The penalties may mean 2013 results fall below analyst estimates at the two hospital chains, according to a note today (Sept. 19) from Sheryl Skolnick, an analyst at Stamford, Conn.-based CRT.
Community Health, the second-biggest U.S. hospital owner with significant operations in Northwest Arkansas, may lose $14.3 million in Medicare payments, while LifePoint would see a $4.5 million reduction, she estimated.
Medicare, the government-backed program for the elderly, will reduce reimbursements by as much as 1% starting Oct. 1 at hospitals with high readmission rates for patients with heart attacks, pneumonia and other ills. While the initial cuts may be small, they’re due to increase in future years and private insurers may follow suit, Skolnick said.
“For those hospitals receiving either the full or close to the full 1 percent cap on cuts, fiscal 2013 is shaping up to be a painful year,” Skolnick wrote. “The lack of investment in preventing readmissions by controlling the things a hospital can control may well have led to ‘overstated’ earnings.”
The projections are based on government-collected readmission and mortality rates from 2008 to 2011 and may not be as precise as forecasts made by the companies themselves, Skolnick said.
Community Health owns several hospitals and clinics in Arkansas. Those in Northwest Arkansas are:
• Northwest Medical Center-Springdale
• Northwest Medical Center-Bentonville
• Northwest Medical Center-Willow Creek Women’s Hospital in Johnson
• Siloam Springs Regional Hospital
• Northwest Benton County Physician Services in Bentonville
• Northwest Physicians group in Springdale
• Siloam Springs Clinic
The company also owns hospitals and clinics in El Dorado, Forrest City, Helena, and Newport.
Community Health also recently backed away from an Arkansas arrangement with insurance giant Blue Cross Blue Shield.
Community Health expects reimbursement cuts to be smaller, about $5 million to $7 million, said Tomi Galin, a CHS spokeswoman. The company also projects some increased payments from Medicare as it meets other quality incentives, she said in an e-mail.
Quality scores may also endanger profit forecasts at Vanguard Health Systems Inc., she said. The rates were lowest, and the potential penalties less severe, at the biggest U.S. chain, Nashville, Tennessee-based HCA Holdings Inc., as well as for Dallas-based Tenet Healthcare Corp., the No. 3 chain, according to CRT’s analysis.
Cuts to Medicare revenue at individual hospitals may average 0.4 percent at the three companies, Skolnick said.
High readmissions may be explained by higher poverty rates in some areas, though it’s not the whole story, Skolnick wrote. HCA and Tenet operate in many low-income areas yet had higher quality scores than rivals in many cases, she said.
“We think it is now appropriate for investors to hold management teams accountable for not investing in quality improvement programs for the last decade,” she wrote.