Nine nursing homes in the Seacoast region will receive reduced Medicare reimbursements under a federal program that seeks to discourage early discharge and decrease hospital readmission rates of residents.

Known as the Skilled Nursing Facility Value-Based Purchasing Program it was created in 2014 and administered by the Center for Medicare and Medicaid services (CMS).

This year's report evaluated re-hospitalization rates for short-term residents from 2015 to 2017. Facilities with low rates of patient readmission receive a 1.6 percent bonus, while those with the highest rates can have up to 2 percent of payments withheld.

The Seacoast region is not unusual in its results. Out of 72 nursing home or skilled nursing facilities in New Hampshire, only 26 percent (15 facilities) will receive a bonus while 74 percent will receive a reduction of some amount.

The facilities cited in the Seacoast region are (ranked in order of percentage of payment reduction) Clipper Harbor, Portsmouth -1.98 ; Webster at Rye -1.98; Colonial Hill Center and Rochester Manor -1.98 ; Dover Center for Health and Rehabilitation -1.98; Langdon Place of Dover -1.62 ; Riverside Rest Home -1.38 ; St Ann Rehabilitation and Nursing Center -1.34; and Edgewood Center, Portsmouth -0.73.

“We have tracked hospital re-admissions for years, but this is a subset of data that is new to us,” said Lori Mayer, spokesperson for Colonial Hill, Rochester Manor and Langdon Place of Dover.

All three of the facilities are owned by Genesis HealthCare, which is a national company with 400 facilities across 30 states, and operates five out of nine Seacoast-area homes cited for reimbursement reductions. Meyer noted the data used in the report was, “very dated and not necessarily indicative” of the facilities current status.

“However, it does confirm how important it is to minimize the disruption that a patient experiences going back and forth to the hospital.”

The program will move $316 million of Medicare payments from low-scoring facilities to those receiving bonuses. It will also save $211 million that would have otherwise been paid out if not for penalty deductions. Similar programs exist for hospitals and home health agencies.

The program is part of a larger shift to a value based reimbursement system, which seeks to incentivize healthy outcomes versus payment for number of procedures or the amount of diagnosed conditions per patient.

The report’s data suggests that for some nursing homes the strain put on budgets and staff can lead to higher patient re-admission rates. Conversely a hospital, with incentive's for short stays, can release a patient prematurely back to a nursing home. “Patients can be admitted to skilled nursing facilities sooner and sicker than used to be the case,” said Tom Argue, CEO of Webster at Rye.

Although hospitalization of some nursing home residents is inevitable, facilities are taking steps to mitigate re-admissions with additional treatment at the facility.

“Webster at Rye has significantly increased the hours of our medical director who is available in-house for consultation and diagnosis on a regular basis,” said Argue.

At the Genesis operated facilities the effort to reduce re-hospitalizations includes the use of evidence-based improvement tools, such as the eInteract program which uses technology to monitor patient condition. “We expect to see current improvements reflected in the future based on recent efforts,” said Meyer.

“The program’s reduction in funding does not impact the amount or quality of services provided, but it most certainly makes it that much more difficult,” said Argue, who cited other cuts in reimbursements over the past decade, including state Medicaid, has left facilities struggling to stay solvent. “Especially with the current staffing shortage and its impact on wages.”

The results of this report and any payment reductions do not indicate the quality or rating of any facility. A consumer rating can best be found through the CMS star rating system at https://www.medicare.gov/nursinghomecompare/search.html?