Spare the rod and spoil the child.
Medicare fined 2,610 hospitals, a record, for too many re-admissions.
Interestingly, the national rate for readmissions is getting lower. Still, last year, 18% of Medicare patients were re-admitted within a month. Medicare believes these re-admissions costs them $26 billion; and that $17 billion comes from potentially avoidable readmissions.
Under the new fines, ¾ of hospitals subject to the Hospital Readmission Reduction Program are being penalized. Over the next year, these hospitals will receive lower payments for ALL Medicare payments they received – not just for those patients they readmitted. The total – $428 million. A drop in the bucket compared to all Medicare payments.
Now, many hospitals are exempted from the Program – actually over 1,400 facilities. These include certain cancer hospitals, critical access hospitals, psychiatry and rehab facilities. Maryland hospitals are also exempt as they have a separate payment program with Medicare.
In New Jersey, almost every hospital will be penalized. So will a majority of hospitals in 28 other states.
Some penalties are just a slap on the wrist. Others are a serious chunk of change. Those with the highest readmission rates will see a haircut of 3% for each Medicare payment. You might say – 3%; that’s chump change. But, for some facilities that depend upon Medicare for its survival, that difference might be another nail in a coffin.
Medicare levied penalties against 433 MORE hospitals this year compared to last. Why? There are more categories being measured. Two new categories include elective hip/knee replacements; and lung ailments such as chronic bronchitis. This adds to the list that already included congestive heart failure, myocardial infarct, and pneumonia. A hospital was fined if it had higher than expected readmission rates in ANY category. Thus, a number of specialty hospitals that focus on hip and knee replacements received fines for the first time because readmissions of those patients are now being assessed.
Some hospitals have hired consultants to help prevent re-admissions.
Gina Kaurich, director of client-care services at the Cincinnati-based FirstLight HomeCare, one such consultant, said:
Some have tried to care for returning patients without readmitting them overnight so Medicare does not count their cases, she said. Others have assigned their own nurses to visit patients at home shortly after discharge to ensure the patients are properly taking care of themselves. Still others hire private companies like hers, which sends nurse assistants to homes.
It’s a noble goal to cut down on preventable re-admissions. But, that competes with the goal of getting the patient out of the door ASAP to keep costs down – or because the patient does not want to be exposed any longer than necessary to antibiotic-resistant bugs. With so many hospitals getting dinged, you have to wonder if this readmission prevention program was designed properly.
What do you think?
The “hospitals” helped in “making this bed”,and now,they too are going to have to sleep in it! SO MUCH HAS CHANGED in the past ten years…I send a post-op pt. to the I.C.U.,and within a few minutes,or hours,some,if not all of my orders are being changed or ignored.There are “I.C.U. Specialists”,hired by the hospital,who,I believe,are pressured to get pt.out ASAP,(even to Hospice),without informing me. It seems to me that a lot of these decisions are made to cut costs/expenses,(ahead of “pure” medical decisions. Obviously,this is true of pts. on the wards as well,whose care is dictated by hospitalists;also getting their paycheck from the hospital.Now,I am afraid they will have to play a more controlled balancing act,and hope it works. What a disgraceful way we now practice medicine!
Not discussed in this article is the potential impact on doctors who themselves do the re-admitting. There has to be an impact on these physicians, when it comes to their potential re-appointment for staff privileges or in an employment situation…if they are to have a chance at being rehired.
I believe both negative impacts will occur on your career if you have “too high” a re-admission rate. There is no doubt that the hospitals, especially those that have been dinged, will be keeping track of you.
This is further reason to try to remove smokers, drinkers, non-compliant patients and recreational drug users from your practice, or cut them to a very basic minimum. Besides the elderly, those people have the greatest likelihood of necessity for re-admission. This presents a special challenge to oncologists, who see as a matter of course…persistent re-admissions for terminal care.
Oncologists need to get together and have some kind of “discourse” with Government regulators to work out a truce. I would suggest a kind of sliding scale for oncology re-admissions for terminal care, vs. hospice and admissions for hospice. Without an aggressive pro-active stance, oncologists will see themselves under greater attack from Obamacare. The writing is on the wall.
I’m not sure who will be responsible to manage the increasing drug activity in this Country and the permissive attitudes that go along with this. More “minor” drug addicts will be released from prisons as pot laws weaken. I’m not saying this is a bad or good thing. I am saying it will have an impact on your practices.
Our society itself is aging, which directs our demographics to increased re-admissions. This will occur no matter what you do or don’t do in your practice. But those who decide to take on Government as a target will be thrashed down and will suffer irreparable damage to their careers. Before you decide to take this on, which admittedly is the moral thing to do, you must first thoroughly think-out this decision and map out a strategy for after you are fired or lose your hospital admitting privileges.
By yourself you will never be able to fight Government or their forces. An alternative is to encourage retired physicians to take this on. I did this with OIG after I retired. I was effective because they no longer had power over me. The formation of groups of retired physicians as a political force has yet to be established. A so-called: “American Association of Retired Doctors” could take on Government and remain unscathed. We have untapped power we are ignoring.
Michael M. Rosenblatt, DPM
I strongly hope that most if not all of the public hospitals that shoulder the burden of care for the poor and for those at risk of health care outcomes disparities are on this “fine” list. I say this not out of mean spiritedness, but out of concern.
Those hospitals care for persons with lower than average health literacy and higher likelihood of not being able to afford their medications are inherently disadvantaged by these rules that are not backed by any science that suggests they are anything but arbitrary.
Perhaps if the safety net hospitals are among the most likely to be fined, the Obama administration, which should look sympathetically at these hospitals, might devise an Executive Order to amend this injustice. As it is, safety net hospitals are being expected to magically solve the poverty-related problems that lead to health care outcomes disparities.
(I do not work at a public hospital but I sympathize with the plight of those who care for these patients).
This is terrible. Readmission for an exacerbation of CHF or COPD is part of the natural history of these diseases, not an attempt of “hospitals” to profit.
If CMS wants to decrease readmissions, they should notify the beneficiaries upon discharge that any return to the hospital within X days will result in partial financial responsibility of the beneficiary.
ED Physician in KS and Dr. Joseph are both correct: It is much cheaper for Government if patients simply die earlier in the course of “therapy” at home, or at least outside of a hospital. This is what they are really talking about.
Instead of silly hospital-penalty games, Government should simply be honest and call this what it actually is: Death management by cost differential.
As usual, physicians are forced to be on the front lines of a game-playing liberal Government. Guess whom the patient’s family will sue? Hint: It won’t be Government.
If you treat elderly or severely compromised patients, it is time for you to start EDUCATING your patients and their families’ on what these new policies will mean to them. A patient hand-out to all of your hospital admission patients would be entitled: “WHAT RE-ADMISSION HOSPITAL PENALTIES MEAN TO YOU AND YOUR FAMILY.”
Then, supply them with the local Medicare Office telephone number and their Congressperson to contact. At least then, when their hospital re-admission is refused or they wonder why you are so reticent about re-admitting them, they may understand where the blame should go.
Michael M. Rosenblatt, DPM
Well intentioned policies can have unintended consequences. There is no doubt that we are in a disruptive period of time and we simply have no idea how to solve problems created by poorly crafted policies. When we are lost, we simply back track our steps or until we find the Way. If we are sophisticated and lucky to have a GPS we click on the “home” button. The Way is simple: bring market forces to bear. Right now we have vertically integrated (insurance, hospital and physicians) systems that are veritable 21st century health monopolies. Monopolies do not lower prices or improve services. We all know that. We can only hope that those who are elected to govern The People have the moral North and the Ethical Home to enforce the Sherman Antitrust Act in defense of patients who are the ones that are really paying a dear price- in more ways than one.
I keep saying we brought this on ourselves by weak leadership over the years.Imaginel letting people who no next to nothing about real medical care and the unpredictability of diseases being able to equate patients with business outcomes.Medicine has become a total bottom line business,using unpredictable patients as income producers and blaming doctors and hospitals if the business model ddoesnt follow a predictable line.
Medicare created this situation by determining that patients had to be out of the hospital after three days or reimbursements will stop for a particular diagnosis, regardless of the patient’s medical condition. When the inevitable happened, Medicare expressed shock and horror at patient’s being readmitted within 30 days. Currently the hospitals are a buffer absorbing these financial losses.
Hospitals will now try to shift re-admissions to other facilities or refuse to care for sick patients entirely. Local hospitals will become quick stop byways on the road to a major tertiary center.
The cost shifting and blame will not stop until the government takes over full control of the health system. Then the true rationing and panels about the cost of care for the chronically ill and elderly will commence.
Hopitals should be very careful in dealing with readmissions in order to avoid this kind of problem once again. Medicare is very careful in making sure that they are not abused in order to avoid financial losses so measures should be implemented to avoid problems while still facilitation quality health care.
Testosterone Lawsuits, I think I get your point. But unless you are offering “suggestions” on how Medicare will reduce re-admissions, your post does not have full value.
Re-admissions must be tied to the patients’ health conditions. As long as those are “honestly reported” then there should be no concern about over-use and abuse. Doctors no longer have operating control or monetary interest in the hospitals they work for, or at. Therefore, we can make a reasonable assumption that most re-admissions are backed by the patients’ chart. It is possible that doctors might make more money by chronic re-admissions, but even if that is true, as long as the re-admission is backed by the chart, then it is “honest.”
The reason why I object to charging hospitals penalties for “excessive-readmissions” is that apparently there is no evaluation of those re-admissions. Perhaps there is. But there is no indication of it in the article.
Medicare policy often creates an atmosphere of fear and distrust among providers. Medicare (in my experience) seems to oscillate between creating fear and horror among providers one year…and being big, kindly brother the next year…keeping us all off base and confused. I think this is political. One year they need to show Congress they are tight on the purse strings, and over-do heavy handed policy. The next year, Medicare realizes they over-reacted and they try to repair the damage they caused.
This back-and-forth assault is ridiculous and keeps us all up-tight and unbalanced. I believe this is deliberate. Sad to say, but that’s what I believe.
Michael M. Rosenblatt, DPM