Monday, May 9, 2016

Mass. Made Mistakes Getting Medicare Money

The math didn't add up, and you call it the Nantucket Effect because it was caused by John Kerry no longer being in the Senate:

"How a tiny hospital has imperiled Mass. Medicare funds" by Liz Kowalczyk Globe Staff  May 02, 2016

Simple math errors at a tiny Massachusetts hospital have created big problems for other hospitals in the state, contributing to a potential $160 million drop in federal Medicare payments over the next year.

Maybe they could call in the CDC for help.

A loss that steep — 10 percent of Medicare funding for the hardest-hit hospitals — could force layoffs of 2,000 staff, with cuts concentrated outside Boston, according to estimates by the Massachusetts Council of Community Hospitals.

The quaint 19-bed Nantucket Cottage Hospital, owned by Partners HealthCare System and considered the state’s only rural hospital, has for years had an outsized impact on hospital finances statewide — but usually for the better.

Nantucket sets the floor for wage reimbursements at hospitals across the state. And because Nantucket’s wages are high, due to its remote island location and steep cost of living, that has created bonuses for many other Massachusetts hospitals in recent years.

Not this year. Consultants hired by Partners made several errors that led to lower wages being reported to Medicare for Nantucket Hospital. They overestimated hours, thereby reducing the hourly rate, and did not include enough higher-paid physician hours and overtime pay, according to an e-mail from the Massachusetts Hospital Association obtained by the Globe.

Those mistakes, combined with another smaller adjustment to Nantucket’s wages, would result in a “steep and extraordinarily serious’’ decline in Medicare payments, wrote the association’s general counsel, Timothy Gens, in the e-mail. He said “the situation is further complicated by the fact that the [Medicare] deadline for corrections has passed.’’ The rates affect the next fiscal year, beginning in October.

Partners, the largest hospital and physician network in the state, acknowledges it did not catch the consultants’ mistakes when it submitted the data to Medicare in September. Spokesman Rich Copp said the organization recognized a problem in mid- to late March and sent corrected numbers April 5 — almost two months after the deadline for corrections.

Regardless, he said, Medicare has a responsibility to use the corrected data. “Any other course of action will hurt hospitals in every corner of the state,’’ Copp said.

Hospitals have enlisted the state’s congressional delegation in their appeal.

“It was a very expensive mistake,’’ said Representative Michael Capuano. “But it was still a mistake.’’

Representative Richard Neal said he recently spoke to Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, and expects to meet with Health and Human Services Secretary Sylvia Burwell this month. Hospitals in his Western Massachusetts district would be among the hardest hit by the cuts. The wages “have to be submitted with meticulous attention paid to detail,’’ he said. “That’s how sensitive this data is.’’

They really care about your health, huh?

About $115 million of the $160 million reduction is due to the math errors, while the remaining $45 million is a result of separate findings made by Medicare auditors about Partners’ Nantucket submission. Partners also appealed the later findings, in that case before the deadline....


There is a simple solution for all this: don't get sick in Ma$$achu$etts.

I'm wondering if this was more than a "mistake" and a sly way of cutting health costs.