Barnes-Jewish Hospital continues to struggle with high numbers of Medicare patients who return soon after they've been discharged, new federal data show. The hospital's performance is likely to trigger a loss of Medicare payments in coming years.

The hospital, in the Central West End, is one of just three hospitals in the country to perform significantly worse than the national average in readmissions within 30 days for three conditions — heart attacks, heart failure and pneumonia — for each of the last three years. The two other hospitals are Our Lady of the Resurrection in Chicago and Beth Israel Deaconess in Boston.

At Barnes-Jewish, more than 28 percent of Medicare patients who were treated and released for heart failure were readmitted within a month, up from 26 percent in 2009. The national average is 24.8 percent.

Medicare, the government health plan for people older than 65, plans to penalize hospitals with higher-than-expected readmission rates. Under health care reform, Barnes-Jewish and other hospitals could face up to a 3 percent reduction in Medicare payments, meaning millions of dollars, starting next year.

Reducing readmissions nationwide could save $26 billion over a decade, the government estimates.

While reducing readmissions is an important goal, hospitals should not be punished for treating underserved populations, said Dr. John Lynch, chief medical officer at Barnes-Jewish.

"If you believe, and we do, that there are significant social and economic factors driving the root causes of readmission, Medicare's strategy to penalize providers who deal with those populations could potentially be flawed," Lynch said.

The idea that hospitals have responsibility to their patients after they leave is relatively new.

"There was a lack of appreciation for the fact there was a very high-risk period after people went home. You're trained to be happy to get them out the door," said Dr. Harlan Krumholz, director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation. "We're trying to hold their hand a little bit more and make sure that passage occurs a little more smoothly, a little more safely."

Though the readmission data are adjusted to equalize the severity of patients' illnesses, social and economic factors are not taken into account. That's in part because hospitals can do more to help patients surmount those challenges, said Krumholz, who helped write the framework for the data.

Some readmissions are preventable, Krumholz said. Maybe a patient wasn't ready to leave in the first place or the hospital did not provide adequate follow-up instructions.

"I have heard some hospitals begin to blame the patients for their performance, which suggests they don't have marked opportunities to improve," Krumholz said. "There are some that have figured out ways to succeed better than others."

A pilot program to reduce readmissions at Barnes-Jewish was terminated earlier this year after only modest improvements. The hospital plans to revamp the program to address literacy and transportation problems found to be the primary barriers to patients' follow-up care.

In the new program, high-risk patients could receive a starter pack of medications on discharge. A nurse will visit patients at home within 24 hours. Between 25 and 50 patients a week will be transported back to the hospital within six days for a follow-up doctor's appointment.

"Since St. Louis does not have a city or county hospital anymore, we essentially serve that very important role of being a safety-net hospital for the region," said Lynch.

He also stressed that Barnes-Jewish is credited with readmissions for patients who were originally referred from other hospitals for more specialized care. Barnes-Jewish is the only hospital in the region that performs adult heart and lung transplants, for example.

Still, he acknowledged, there is room for improvement.

"We're always looking to do better than our current performance, and we know that there are opportunities," Lynch said.

The updated federal data also included hospitals' 30-day death rates for heart attacks, heart failure and pneumonia. Barnes-Jewish scored better-than-expected mortality rates for heart attack and heart failure.

One policy analyst said mortality rates were a better indication of a hospital's quality than were readmissions.

"To me, the primary job of the hospital is to make sure when the patient is admitted they do well, they get good care," said Dr. Ashish Jha, associate professor of health policy at the Harvard School of Public Health. "Nobody wants to be readmitted, but that's a far cry from dying in the hospital."