Hospital report cards
After scoring well in the U.S. News and World Report rankings, Boca Raton Regional Hospital did less well on another list that has come to have much importance.
It’s the annual report on how much hospitals must pay in penalties based on the rate of Medicare patients who return less than a month after being discharged. The Hospital Readmissions Reduction Program, which is part of the Affordable Care Act, is designed to make hospitals offer better care the first time—and thus save Medicare money from not churning patients.
This is the fourth year that the system has been in place. Boca Raton Regional had done very well. The hospital paid no penalties the first two years, and paid just 0.18 percent on its Medicare revenue last year.
According to a nationwide compilation by Kaiser Health News, however, Boca Regional’s penalty for the 2016 fiscal year will be 0.8 percent—more than a fourfold increase. The maximum penalty is 3 percent.
Some hospitals have argued for changes to the program that would better reflect the difficulties of caring for poorer patients. But Boca Regional, West Boca Medical Center and Delray Medical Center have a mostly affluent patient base.
West Boca’s penalty for 2016 will more than double, from 0.22 percent to 0.50 percent. Delray Medical Center went from being penalized hardly at all over the first three years to a penalty of 0.22 percent.
No south-county hospital, though, did as well as Bethesda, which probably has the area’s lowest percentage of affluent patients. Bethesda East’s penalty will be just 0.11 percent, barely up from last year. Belle Glade’s Lakeside Medical Center—which is in the poorest part of Palm Beach County—will be penalized 0.6 percent.
Despite that jump, Boca Regional looks better than some other prominent county hospitals. JFK will pay 1.35 percent, while Jupiter Medical will pay 1.07 percent after paying nothing the first three years.
Kaiser reports that the government based the fines on readmissions between July 2011 and June of last year for heart attack, heart failure, chronic lung problems, pneumonia and elective hip or knee replacements. The Centers for Medicare and Medicaid Services based its decision on what the agency considered to be an appropriate readmission rate and the hospital industry’s overall performance. More than half of the nation’s hospitals received penalties.
In response to my request for comment, Boca Regional’s chief medical officer, Charles Posternack, said:
“First, it is important to underscore that the methodology of the current report is more complex and is based on 2013 data. That said, our increase seems to be attributable to results related to total joint replacement. All our other core measures reflect performance at or bettering expectations.”
With total joints, prior standards were so low that, with the new methodology, having just one or two outliers can skew results materially and impact overall performance. This appears to be the case at Boca Regional.
“Our examination of more recent date for joint replacement shows 2013 to be an aberration, and our results going forward across the spectrum of Diagnosis-Related Groups being analyzed should be at expectation or better.”
Boca vs. Police-fire pension board
I wrote recently about the dispute between the Boca Raton City Council and the city’s police-fire pension board. The city believes that the board is incorrectly interpreting part of the new contracts as they relates to benefits. On July 28, the council passed a resolution stating that the board’s decision posed “an immediate danger to the health, safety or welfare of the public. . .” and threatened court action.
For the moment, Mayor Susan Haynie said, attorneys for the city and the board are talking. For the moment, the board has backed off on further defiance, which Haynie on Wednesday called “a good sign.” City Manager Leif Ahnell is working on a report that would specify the potential financial impact if the board’s interpretation stands.
Boca negotiated new, three-year contracts—starting this year—with the police and fire unions. Projections are that the contracts would save the city about $90 million in pension costs over 30 years.
Redrawing districts
Legislators working on the state’s new congressional map will hear today from Palm Beach and Broward residents who favor the current configuration that places Democrats Lois Frankel and Ted Deutch in roughly parallel districts that include both counties. Judging by what happened Tuesday, these speakers may not be prepared.
The Legislature has to draw new districts because the Florida Supreme Court invalidated the current ones, which the Legislature drew in 2012 and tried to redraw last year. The new map under discussion in the current special session changes 22 of the state’s 27 districts.
Members of the House and Senate redistricting committees made clear during an all-day session Tuesday that those who want changes should come with a statewide map that incorporates the effects their preferred changes would result in elsewhere.
The new map places Frankel’s district in Broward except for Boca Raton and Highland Beach. Deutch would lose his Broward portion and take over the coastal areas from Delray Beach north to West Palm Beach. Critics say coastal cities in Palm Beach and Broward have shared interests, and thus should share their member of Congress. I don’t accept the argument, but the bigger problem may be that they don’t have an alternative statewide map that the Legislature’s lawyers believe would satisfy the court, which could have the final say.
CRA payment plan amended
By a 3-2 vote, with Mitch Katz and Shelly Petrolia dissenting, the Delray Beach City Commission on Tuesday agreed to amend the payment plan with the community redevelopment agency for land related to the Fourth and Fifth Delray (iPic) project. Later, though, a seemingly innocuous vote on sidewalk relief for a coastal homeowner went, well, sideways.
Staff recommended that the commission agree to accept about $3,000 in lieu of the owner having a 75-foot sidewalk. A discussion about how the city can use such money devolved into an argument about City Attorney Noel Pfeffer, who recently had his formal evaluation. One hopes the hard feelings don’t last. The iPic project itself is on Tuesday’s agenda.
More on Cooper
I wrote about Tuesday about the impressive status report Delray Beach City Manager Don Cooper has compiled on city issues. Here’s another example of the thorough review Cooper is giving city government.
For the current budget year, which ends Sept. 30, Delray Beach gave nearly $2 million in property tax revenue to non-profits and charities. The recipients ranged from the Boys and Girls Club to the city library, which operates independently from city government.
In a report to the city commission for its Tuesday meeting, Cooper points out that city policy recommends no more than a one-percent donation to non-profits from property tax revenue. For next year, that would be about $517,000. The requests from 32 groups, though, among to almost $2.4 million.
Cooper formed a committee, which is recommending that the city spend between $655,000 and $922,000, depending on how much the library gets. Many of the organizations that would receive no money support worthy causes—the American Cancer Society, Habitat for Humanity, Legal Aid of Palm Beach County. Many, however, either overlap with city services or provide little direct benefit, and have other sources of money.
Meanwhile, Delray Beach has identified tens of million in unmet basic needs for which there is one main source of money—property tax revenue. Cooper isn’t being mean. He’s being fair.
About the Author
Randy Schultz was born in Hartford, Conn., and graduated from the University of Tennessee in 1974. He has lived in South Florida since then, and in Boca Raton since 1985. Schultz spent nearly 40 years in daily journalism at the Miami Herald and Palm Beach Post, most recently as editorial page editor at the Post. His wife, Shelley, is director of The Learning Network at Pine Crest School. His son, an attorney, and daughter-in-law and three grandchildren also live in Boca Raton. His daughter is a veterinarian who lives in Baltimore.
