Medicare fines over hospitals' readmitted patients (ObamaCare Kick In)

[OldUSAFSniper]

A doctor that I know here in Tulsa, has already switched to "Cash Only." It costs him so much money to take Insurance and government programs that it absolutely is not worth it. Plus, medicare and medicaid never pay him the full amount for a procedure. He has went to a system where you pay a certain amount a month, just like a car payment. For that amount of money, you can see him as many times as you want a month. All procedures and treatments outside of a consultation is charged by what they are. When patients go into see him they receive a "price list" for the services that he provides and you sign a patient contract with him. He has been able to reduce his office staff in half and his costs have plummeted. Therefore, he makes more with much less hassle.

You want to know where he got the idea? He went to a medical convention and got to talking to a bunch of doctors who have begun this type of relationship with their patients. Where were they from? The original group was from SEATTLE and another group was from SAN FRANCISCO. The irony of this is just almost too much to bear.

He has more business now than when he took insurance and the government programs. He's doing so well that there are groups of doctors here in Tulsa that are looking into what he is doing and are going to emulate his system.

You know, you stick your liberal finger into a festering sore and people will find a way around it. Just like the large magazine and assault weapon ban from Clinton's day. Just like making hooch in prison. God, will you left-wingers NEVER learn... that was a really stoopid question. Of course, you won't.

 

[dblack]

Who is "we"? How are hospitals held accountable for too many preventable readmissions right now ... er, before this part of ACA?

I agree that not all readmissions are preventable and they need to look at the reasons for the reamits, not just lump them all together.

"We" is society, those of us considering these reforms. We can, and should, address irresponsible discharges the same way we handle any kind of negligence or malpractice.

What we're looking at (in general, across government really) is a shift away from a legal structure that holds people accountable for poor judgement, to one that supersedes individual judgement with the pre-defined dictates of the state. In other words, from a government that punishes bad actors to one that simply tells us how to act in the first place.

 

[Katzndogz]

People also get readmitted because they get worse. They just get worse. They have a knee replacement that's working fine and then malfunctions. They are treated for a stroke, and then have another stroke. This law is designed to prevent sick people from getting medical care. There's no real way around it. Noomi said it correctly, the people should just be denied care until they die in the hospital doorway. This is what the democrat goal is. Deaths, otherwise preventable, is the fastest way to reducing medical costs.

Some readmissions are preventable and those are what this seems to be addressing.

When my youngest was born (unplanned c-section) I ended up leaking spinal fluid from the epidural (advice: ALWAYS have the anesthesiologist administer the anesthesia!) due to the ob botching the epidural. I had to be readmitted for a day two days after I was discharged in order for them to fix it. Had they paid better attention to my constant complaint of a headache since shortly after my daughter was born, that readmission could have been avoided.

In reality, if a mistake was indeed made, the hospital just would not have readmitted you. The one thing that you can count on, if it's a mistake no one knows in advance that it was a mistake. You just wouldn't have been readmitted. Your family might have a wrongful death action against the hospital for releasing you too early but it wouldn't help you at all.

 

[OohPooPahDoo]

Medicare fines over hospitals' readmitted patients (ObamaCare Kick In)
Google AP ^ | Sept 30, 2012 | RICARDO ALONSO-ZALDIVAR

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.

-snip-

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.

-snip-

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

The Associated Press: Medicare fines over hospitals' readmitted patients

Obongo care sucks!

Very good alternative solution you have.

 

[WillowTree]

People only get readmitted because they were not properly treated in the first place. Perhaps this will force hospitals to treat their patients, instead of sending them off with a pack of painkillers.

Foolish person.

 

[OohPooPahDoo]

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...

The fine comes if the TOTALS of readmitted patients are too high, not if ONE patient is readmitted. Do you honestly think its a complete coincidence that some hospitals have markedly high readmission rates than others?

What incentive do the hospitals have to ensure their Medicare patients are NOT readmitted for the same condition? None. In fact, without the new rule it works the OTHER way. A patient gets readmitted - you make MORE money. Why you and the right want to keep this perverse incentive system where doctors are paid MORE for WORSE care is beyond me.

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?

Or not. Maybe since the hospital no longer profits from grandma's readmission, they took the time to adequately explain to her how to treat her wound post-surgey.

 

[Katzndogz]

The hospitals with the highest readmission rates are tertiary care hospitals. Poorly performing hospitals don't have high readmission rates, they have high death rates of people at the hospital.

 

[masquerade]

People only get readmitted because they were not properly treated in the first place. Perhaps this will force hospitals to treat their patients, instead of sending them off with a pack of painkillers.

Bullshit.
Back up your claim please.

 

[geauxtohell]

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...

The fine comes if the TOTALS of readmitted patients are too high, not if ONE patient is readmitted. Do you honestly think its a complete coincidence that some hospitals have markedly high readmission rates than others?

What incentive do the hospitals have to ensure their Medicare patients are NOT readmitted for the same condition? None. In fact, without the new rule it works the OTHER way. A patient gets readmitted - you make MORE money. Why you and the right want to keep this perverse incentive system where doctors are paid MORE for WORSE care is beyond me.

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?

Or not. Maybe since the hospital no longer profits from grandma's readmission, they took the time to adequately explain to her how to treat her wound post-surgey.

It's absurd to suggest that physicians are intentionally hurting people to drive profit.

The hospitals that this hurts will be the hospitals that are currently caring for the poor.

How do we factor in the fact that my patients, who refuses to stop smoking, has been readmitted 15 times for COPD? To some degree, readmission is driven by the chronic health problems secondary to a lifetime of poor decisions made by the oh-so-noble patient?

Like the HCAP reimbursements, this is insane.

 

[geauxtohell]

People only get readmitted because they were not properly treated in the first place. Perhaps this will force hospitals to treat their patients, instead of sending them off with a pack of painkillers.

Foolish person.

I rarely agree with you.

This time I do.

That is an extraordinarily foolish statement.

 

[OohPooPahDoo]

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...

The fine comes if the TOTALS of readmitted patients are too high, not if ONE patient is readmitted. Do you honestly think its a complete coincidence that some hospitals have markedly high readmission rates than others?

What incentive do the hospitals have to ensure their Medicare patients are NOT readmitted for the same condition? None. In fact, without the new rule it works the OTHER way. A patient gets readmitted - you make MORE money. Why you and the right want to keep this perverse incentive system where doctors are paid MORE for WORSE care is beyond me.

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?

Or not. Maybe since the hospital no longer profits from grandma's readmission, they took the time to adequately explain to her how to treat her wound post-surgey.

It's absurd to suggest that physicians are intentionally hurting people to drive profit.

I didn't. I suggested that under the old system Medicare readmissions meant more profits to the hospitals. And they did. Its simple math. More services rendered = more money. Now the perverse incentive is gone. You actually profit more if the job is done right the first time.

 

[masquerade]

Of course they will refuse to readmit patients. They are fined no matter what the reason. If someone is wise, they just won't go back to the hospital where they got their treatment. Go to a different hospital.

It doesn't matter if the beneficiary is admitted to a different hospital, if it's within 30 days of the discharge the original hospital still gets dinged for the readmission. There's no benefit to diverting someone to a different facility, the readmission is still counted against the original hospital's numbers.

The way to avoid the penalties is to provide the supports the patient needs to avoid preventable complications and readmissions after they leave the hospital. As many hospitals are starting to do. That's good for the patient, it's good for Medicare (and the taxpayer), and it's good for the hospital.

Unless of course the hospital has a client base of homeless, substance-abuse patients in which it's more difficult to keep these patients out of the hospital.

 

[OohPooPahDoo]

People only get readmitted because they were not properly treated in the first place. Perhaps this will force hospitals to treat their patients, instead of sending them off with a pack of painkillers.

Foolish person.

I rarely agree with you.

This time I do.

That is an extraordinarily foolish statement.

Tell us - what would a PRIVATE insurer do if it concluded a particular hospital it provides coverage at had too high a readmission rate?

 

[OohPooPahDoo]

However, these studies also found that audits of hospital discharge documents, which are often
physician-dictated and transcribed, demonstrated a frequent absence of such information.
Discussing a number of these studies, the authors found that discharge summaries lacked the
following information (results were reported as a range of percentages): diagnostic test results,
33%-63% of the time; the treatment or hospital course, 7%-22% of the time; discharge
medications, 2%-40% of the time; test results pending at discharge, 65% of the time; and followup
plans, 2%-43% of the time.36 In addition, only between 12% and 34% of physicians treating a
patient after a hospital discharge had a copy of the patient’s hospital discharge summary.37
Outpatient physicians who do not have complete and timely information about a patient’s case
may not make adequate follow-up care decisions.

http://www.ncsl.org/documents/health/Medicare_Hospital_Readmissions_and_PPACA.pdf

 

[geauxtohell]

Foolish person.

I rarely agree with you.

This time I do.

That is an extraordinarily foolish statement.

Tell us - what would a PRIVATE insurer do if it concluded a particular hospital it provides coverage at had too high a readmission rate?

What do they do right now?

Is it reasonable not to reimburse for HCAP/VAP.

If you are intubated, odds are you will get VAP. The alternative is to die from respiratory failure.

 

[masquerade]

ah yes....the "new approach to health care delivery".......code words for socialized medicine....

Obamacare IS going to change the hospital-doctor-patient model......doctors and hospitals will be forced to start to working in groups like former HMOs.....remember how crappy those were?

Your doctors and other providers should be working together to coordinate the care you're receiving in different settings. If they're not (and at present they probably are not), that's expensive, wasteful, and potentially dangerous. That fragmentation in health care delivery, where Doctor A doesn't know what Doctor B is doing to the patient, is a major problem with the way things work now. It leads to a lot of money getting spent that doesn't improve the health of the patient or the quality of the care they're receiving, and in the worst cases it can actually result in injury or death.

That's why Obamacare is encouraging providers to work together more closely. But unlike HMOs, Medicare beneficiary choice of providers isn't restricted under the new models they're launching. Patients retain their choice of doctors and hospitals, but those providers are financially responsible for the quality (not just the quantity, as has historically been the case) of care they're providing to patients--they have to show they're doing a good job, including in the experience of care from your point of view as the patient, and coordinating your care with other providers you may be seeing. It's the best of both worlds.

An Accountable Care Organization.

Folks from every area of the healthcare profession ( MD's, RN's, Case Managers, Social Wokers, SNF's, Rehabs, Patient Navigators, etc ... ) all working together to ensure the patient ( medically complex seniors ) gets the best treatment, a safe discharge, continued wellness and an avoidable readmission.

 

[CrusaderFrank]

"we need death panels" -- Obama adviser Steve Rattner 9/16/2012

 

[geauxtohell]

However, these studies also found that audits of hospital discharge documents, which are often
physician-dictated and transcribed, demonstrated a frequent absence of such information.
Discussing a number of these studies, the authors found that discharge summaries lacked the
following information (results were reported as a range of percentages): diagnostic test results,
33%-63% of the time; the treatment or hospital course, 7%-22% of the time; discharge
medications, 2%-40% of the time; test results pending at discharge, 65% of the time; and followup
plans, 2%-43% of the time.36 In addition, only between 12% and 34% of physicians treating a
patient after a hospital discharge had a copy of the patient’s hospital discharge summary.37
Outpatient physicians who do not have complete and timely information about a patient’s case
may not make adequate follow-up care decisions.

http://www.ncsl.org/documents/health/Medicare_Hospital_Readmissions_and_PPACA.pdf

The fidelity of discharge summaries is an entirely different matter. There is a line of thought that d/c summaries need to be very brief and omit a lot of that stuff to.

The entire medical record is always available, so I don't see he point in writing a novella for a D/C summary.

 

[OohPooPahDoo]

I rarely agree with you.

This time I do.

That is an extraordinarily foolish statement.

Tell us - what would a PRIVATE insurer do if it concluded a particular hospital it provides coverage at had too high a readmission rate?

What do they do right now?

Is it reasonable not to reimburse for HCAP/VAP.

If you are intubated, odds are you will get VAP. The alternative is to die from respiratory failure.

Didn't really answer the question.

 

[geauxtohell]

Tell us - what would a PRIVATE insurer do if it concluded a particular hospital it provides coverage at had too high a readmission rate?

What do they do right now?

Is it reasonable not to reimburse for HCAP/VAP.

If you are intubated, odds are you will get VAP. The alternative is to die from respiratory failure.

Didn't really answer the question.

Do they deny coverage right now or do they pay for services rendered?