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WASHINGTON (AP) If you or an elderly relative have been hospitalized recently and noticed extra attention when the time came to be discharged, there's more to it than good customer service.
As of Monday, Medicare will start fining hospitals that have too many patients readmitted within 30 days of discharge due to complications. The penalties are part of a broader push under President Barack Obama's health care law to improve quality while also trying to save taxpayers money.
About two-thirds of the hospitals serving Medicare patients, or some 2,200 facilities, will be hit with penalties averaging around $125,000 per facility this coming year, according to government estimates.
Data to assess the penalties have been collected and crunched, and Medicare has shared the results with individual hospitals. Medicare plans to post details online later in October, and people can look up how their community hospitals performed by using the agency's "Hospital Compare" website.
It adds up to a new way of doing business for hospitals,
Still, industry officials say they have misgivings about being held liable for circumstances beyond their control. They also complain that facilities serving low-income people, including many major teaching hospitals, are much more likely to be fined, raising questions of fairness.
"Readmissions are partially within the control of the hospital and partially within the control of others," Foster said.
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Under the health care law, the penalties gradually will rise until 3 percent of Medicare payments to hospitals are at risk. Medicare is considering holding hospitals accountable on four more measures: joint replacements, stenting, heart bypass and treatment of stroke.
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Under Obama's health care overhaul, Medicare is pursuing efforts to try to improve quality and lower costs. They include rewarding hospitals for quality results, and encouraging hospitals, nursing homes and medical practice groups to join
Many of the hospitals being penalized say they have already launched efforts to reduce their readmissions.
In Western Pennsylvania, an official at UPMCs McKeesport hospital told the Pittsburgh Tribune-Review that it has begun placing nurse practitioners in nursing homes where many of its elderly patients are discharged. Readmissions have dropped by 40 percent since the effort began 18 months ago, but Medicares penalty of 0.68 percent is based on its readmission rates for the three years ending in June 2011, so any improvements werent factored in to the penalty calculation.
In Southwest Florida, Lee Memorial Health System told the News-Press that it used electronic monitoring to keep taps on its sicker patients who had returned home. Patients also receive follow-up calls from staffers and even physician house calls to avoid them returning to the hospital. The hospital will receive a 0.11 percent penalty.
CaféAuLait;6083347 said:Hummmmm re-admit a patient who may have had complications or face a 125,000 dollar fine? Me thinks this may have some hospitals refusing to admit a patient for fear of a fine...
Complications are not always the result of the hospital or doctor, I wonder how they will decide and how much money such an investigation will cost the taxpayer?
Grandma's surgical wound got infected because she did not follow directions and needed to be readmitted for a fever then treatment at a later date because she got sicker. So now we need to investigate each incident?
I think doctors will be afraid to take on new patients for fear they can't control all things regarding their health. Or patients will have longer hospital stays since the doctor will want the patient further along with recovery to reduce the chance of complications.
It never ends well when non-medical people try to call the shots with healthcare or impose penalties by guessing whose fault it is when something goes wrong.
I think doctors will be afraid to take on new patients for fear they can't control all things regarding their health. Or patients will have longer hospital stays since the doctor will want the patient further along with recovery to reduce the chance of complications.
It never ends well when non-medical people try to call the shots with healthcare or impose penalties by guessing whose fault it is when something goes wrong.
a recent Doctor Patient Medical Association poll found that 74% of doctors say they will stop accepting Medicare patients or will leave Medicare entirely because of Obamacare
How Obamacare hurts seniors* - New York Daily News
It never ends well when non-medical people try to call the shots with healthcare or impose penalties by guessing whose fault it is when something goes wrong.
Readmissions
The Commission recommends changing payment to hold providers financially accountable for service use around a hospitalization episode. Specifically, it would reduce payment to hospitals with relatively high readmission rates for select conditions. Conditions with high volume and high readmissions rates may be good candidates for selection. Focusing on rates rather than numbers of readmissions serves to penalize hospitals that consistently perform worse than other hospitals, rather than those that treat sicker patients. The Commission recommends that this payment change be made in tandem with a previously recommended change in law (often referred to as gainsharing or shared accountability) to allow hospitals and physicians to share in the savings that result from re-engineering inefficient care processes during the episode of care.
Currently, Medicare pays for all admissions based on the patient’s diagnosis regardless of whether it is an initial stay or a readmission for the same or a related condition. This is a concern because we know that some readmissions are avoidable and in fact are a sign of poor care or a missed opportunity to better coordinate care.
Penalizing high rates of readmissions encourages providers to do the kinds of things that lead to good care, but are not reliably done now. For example, the kinds of strategies that appear to reduce avoidable readmissions include preventing adverse events during the admission, reviewing each patient’s medications at discharge for appropriateness, and communicating more clearly with beneficiaries about their self-care at discharge. In addition, hospitals, working with physicians, can better communicate with providers caring for patients after discharge and help facilitate patients’ follow-up care.
Spending on readmissions is considerable. We have found that Medicare spends $15 billion on all-cause readmissions and $12 billion if we exclude certain readmissions (for example, those that were planned or for situations such as unrelated traumatic events occurring after discharge). Of this $12 billion, some is spent on readmissions that were avoidable and some on readmissions that were not. To target policy to avoidable readmissions, Medicare could compare hospitals’ rates of potentially preventable readmissions and penalize those with high rates. The savings from this policy would be determined by where the benchmark that defines a high rate is set, the size of the penalty, the number and type of conditions selected, and the responsiveness of providers.
The Commission recognizes that hospitals need physician cooperation in making practice changes that lead to a lower readmission rate. Therefore, hospitals should be permitted to financially reward physicians for helping to reduce readmission rates. Sharing in the financial rewards or cost savings associated with re-engineering clinical care in the hospital is called gainsharing or shared accountability. Allowing hospitals this flexibility in aligning incentives could help them make the goal of reducing unnecessary readmissions a joint one between hospitals and physicians. As discussed in a 2005 MedPAC report to the Congress, shared accountability arrangements should be subject to safeguards to minimize the undesirable incentives potentially associated with these arrangements. For example, physicians who participate should not be rewarded for increasing referrals, stinting on care, or reducing quality.
And hospitals become just a bit more accountable for the quality of the care they provide.
Many of the hospitals being penalized say they have already launched efforts to reduce their readmissions.
In Western Pennsylvania, an official at UPMCs McKeesport hospital told the Pittsburgh Tribune-Review that it has begun placing nurse practitioners in nursing homes where many of its elderly patients are discharged. Readmissions have dropped by 40 percent since the effort began 18 months ago, but Medicares penalty of 0.68 percent is based on its readmission rates for the three years ending in June 2011, so any improvements werent factored in to the penalty calculation.
In Southwest Florida, Lee Memorial Health System told the News-Press that it used electronic monitoring to keep taps on its sicker patients who had returned home. Patients also receive follow-up calls from staffers and even physician house calls to avoid them returning to the hospital. The hospital will receive a 0.11 percent penalty.
Follow up care is good,but It will be an added expense,who will pay??
You think the hospital will eat the additional costs?
The Commission recommends that this payment change be made in tandem with a previously recommended change in law (often referred to as gainsharing or shared accountability) to allow hospitals and physicians to share in the savings that result from re-engineering inefficient care processes during the episode of care.
a recent Doctor Patient Medical Association poll found that 74% of doctors say they will stop accepting Medicare patients or will leave Medicare entirely because of Obamacare
I pray this doesn't destroy our innovativeness within the medical area. I'd love to be able to see a cure for Cancer, Heart Disease within the next 20-30 years.
The additional cost will be passed to non-medicare patients.
But what concerns me is Maobamacare passed Dec 2009, how can they hold these folks to standards that were not in effect on 1 Jul 2008 which would be the start of the three year period? Only in communist America I guess.
I think doctors will be afraid to take on new patients for fear they can't control all things regarding their health. Or patients will have longer hospital stays since the doctor will want the patient further along with recovery to reduce the chance of complications.
It never ends well when non-medical people try to call the shots with healthcare or impose penalties by guessing whose fault it is when something goes wrong.
a recent Doctor Patient Medical Association poll found that 74% of doctors say they will stop accepting Medicare patients or will leave Medicare entirely because of Obamacare
How Obamacare hurts seniors* - New York Daily News
CaféAuLait;6083347 said:Hummmmm re-admit a patient who may have had complications or face a 125,000 dollar fine? Me thinks this may have some hospitals refusing to admit a patient for fear of a fine...
Complications are not always the result of the hospital or doctor, I wonder how they will decide and how much money such an investigation will cost the taxpayer?
Grandma's surgical wound got infected because she did not follow directions and needed to be readmitted for a fever then treatment at a later date because she got sicker. So now we need to investigate each incident?
