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

[masquerade]

Quality of care has nothing to do with it. Patients that drain resources because a hospital is forced to keep them because the patient can't be trusted with follow up care just won't survive the hospital stay. It is putting a decision to the hospitals of releasing the patient and risking a fine, keeping a patient in the hospital to occupy a bed or not having the patient at all.

There are many ways of resolving this problem, not one of them good for the patient.

Hospitals are not forced to keep patients because the patient can't be trusted to with their follow-up care. The hospitals are forced to keep patients because some MD's order tests that could be done as an outpatient. Hospitals are forced to keep patients because a SNF or Rehab won't accept them .... or the patient doesn't have any insurance that would cover a SNF or Rehab. Sometimes hospitals are forced to keep patients because family members don't want to take them home and take care of them.

 

[CrusaderFrank]

"We are God's partners in matters of life and death" -- Obama 2009

 

[Greenbeard]

They seem to be addressing all readmissions.

The penalties are for excess readmissions. The point isn't that there should be no readmissions and that every single one warrants some degree of payment withhold.

What Medicare is going to do is look at a ratio (adjusted actual readmissions/risk-adjusted expected readmissions) over a 3-year performance period. If that ratio is larger than one, there will be a penalty. It's a statistical measure by which the payer is attempting to discern whether those selling the services are performing as well as one would expect given the particular mix of patients they have.

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.

CMS looked at this last year in the Medicare Hospital Quality Chartbook. They looked at the 30-day risk-standardized readmission rates for the three conditions this program is initially focusing on, with particular emphasis on how those rates vary across hospitals based on a few different factors, including the median household income of the hospital's patient population and the proportion of Medicaid patients they serve. What they found is that hospitals are all over the place; plenty of safety net hospitals do as well as or better than hospitals with a high-income client base. Medicaid and poverty-heavy hospitals have only marginally higher readmission rates on the whole.

The trick is always to try and tease out the effects the hospital is having without unduly penalizing them for having more difficult patients. But that's why you have organizations like NQF that are dedicated to making sure measure developers are getting factors like the risk adjustment correct enough to ensure the measures are telling us something with some validity. It's not going to be a perfect measure, particularly (one presumes) not at first. There are legitimate concerns about possible downsides or consequence that will need to be addressed if proved correct, as there are with any important change. But it's well past time to start looking at what we're getting for our dollar.

 

[masquerade]

For the record, reducing readmission rates has been a goal of hospitals around the country long before Obamacare came into play.

Medicare has a rule that a patient being discharged to another facility ( SNF / Rehab ) needs to have three over-nights in the hospital. Even if the patient is cleared medically after day two, they must remain inpatient for three. So there's some way to cut cost. Change that rule.

 

[dblack]

They seem to be addressing all readmissions.

The penalties are for excess readmissions. The point isn't that there should be no readmissions and that every single one warrants some degree of payment withhold.

You know that's not what I was saying. I was responding to Zoom-boing's comment that the law was intended to address "preventable" readmissions. But it doesn't make that distinction. It sets an arbitrary cap on the number of readmissions and fines hospitals if that number is exceeded. I read nothing about any investigation into whether the readmissions were preventable or not.

Again, this is the regulatory preference for dictating practices top down, rather than letting people use their own judgement and holding them accountable.

 

[Greenbeard]

You know that's not what I was saying. I was responding to Zoom-boing's comment that the law was intended to address "preventable" readmissions. But it doesn't make that distinction. It sets an arbitrary cap on the number of readmissions and fines hospitals if that number is exceeded. I read nothing about any investigation into whether the readmissions were preventable or not.

Yes, it does make that distinction. It's not a fine on readmissions, it's a fine on excess readmissions. That's where the preventable part comes in. Some amount of readmissions is expected and normal.

This is not a bean-counter investigating every 30-day readmission in the country to make a subjective (and potentially wrong) judgment of whether that particular readmission was preventable. It's a statistical measure over a 3-year period of the proportion of readmissions in excess of what would be expected over that period given factors like the patient mix of the hospital.

Again, this is the regulatory preference for dictating practices top down, rather than letting people use their own judgement and holding them accountable.

They're not dictating practices. If they were, they be telling hospitals what to do to reduce their readmissions ratios. As it is, they're not. They simply changing what they'll pay to reflect the quality of the care delivered in the hospital, as reflected in this statistical measurement. If hospitals respond by finding ways to improve the quality of that care, that's great. But how they do that is up to them. Results are all that matter here. "Letting people use their own judgment and holding them accountable [for the results they deliver]" is exactly what's happening here.

 

[dblack]

Yes, it does make that distinction. It's not a fine on readmissions, it's a fine on excess readmissions. That's where the preventable part comes in. Some amount of readmissions is expected and normal.

You contradict yourself in the same paragraph. "It's a fine on excess readmisions", NOT excess preventable readmissions. So, no, it's not making that distinction. Please avoid being deliberately obtuse to cloak false arguments.

They're not dictating practices.

Of course they are. They're dictating that hospitals reduce the number of readmissions. It's entirely possible that discharging patients early, and then re-admitting them as necessary, is a good practice. But the regulatory regime dictates otherwise.

Results are all that matter here. "Letting people use their own judgment and holding them accountable [for the results they deliver]" is exactly what's happening here.

No, this is the opposite. This is telling hospitals what to do - lower readmissions - without any attention to the individual details of the results of those readmissions. Blind regulatory bullshit.

 

[Quantum Windbag]

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 UPMC’s 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 Medicare’s penalty of 0.68 percent is based on its readmission rates for the three years ending in June 2011, so any improvements weren’t 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.

Sure they will.

Even if this works exactly as advertised we will only be saving $0.01 out of every $5 spent. If it doesn't work as advertised we will save nothing.