Two New York City Health and Hospitals Corp. facilities are among the New York hospitals with the lowest rates of preventable readmissions.

Hospitals face reductions in their Medicare rates starting in October, and 18 New York City hospitals will have the maximum penalty allowed under the federal health care reform law—1% of their base Medicare reimbursement.

Yet HHC's North Central Bronx Hospital achieved a 0.23% penalty rate, while Metropolitan had a 0.33% rate.

HHC has worked to cut readmissions, pouring resources into care management. The system hired some 40 people in the past five months to handle inpatient care management, and it will hire about the same number to manage patients at home. HHC also follows the Project RED re-engineered discharge program and in 2010 expanded its telehealth initiative, aimed at diabetics, to patients with heart failure.

Yet HHC Chief Medical Officer Dr. Ross Wilson readily admits readmissions "are mostly not preventable." That is particularly true, he notes, of health failure, one of the categories for which CMS is tracking and assessing readmissions penalties for Medicare fee-for-service patients.

Another category is heart attacks, and North Central Bronx doesn't admit such patients. Instead, they are treated at nearby Jacobi or Montefiore. "If you don't have many patients in those categories, you look much better from that point of view, and you don't have a penalty," said Dr. Wilson.

"The key message is: we can't eliminate readmissions," he added, "as we would be keeping people out of a hospital who need to be there."