Area hospitals encountering cost-saving teeth in Obamacare (Penn: homes, live)

[BrianTH]

Article:

Medicare penalizes Western Pennsylvania hospitals for readmissions | TribLIVE

As noted in the article, "Obamacare" includes a variety of measures designed to slow the growth of health care costs, one of which is to try to reduce the frequency of readmissions to hospitals. Readmissions can add a lot to costs with very little benefit to patients, but the prior system did not necessarily give hospitals strong financial incentives to avoid readmissions. So to provide hospitals with more suitable incentives, they will now get penalized through their Medicare reimbursements for excessive readmissions, according to a complex formula. The penalties are starting off relatively mild this year, but will ramp up in future years.

31 of 35 area hospitals are being penalized this year. Hopefully we will see that number going down in future years--as also noted in the article, a bunch of hospitals are already adopting new policies to reduce readmissions.

[Hopes]

Is a readmission an indication that the hospital didn't effectively resolve the problem before discharging the first time?

I know an ultrasound technichian who says the doctors take advantage of medicare patients via unnecessary procedures. For example, an elderly woman in a year long coma but the doctor sends her for an ultrasound claiming she has abdominal pain and then takes her appendix out when it's perfectly fine. Nobody blows the whistle because they need to keep their jobs.

[BrianTH]

Originally Posted by Hopes

Is a readmission an indication that the hospital didn't effectively resolve the problem before discharging the first time?

So the target is "preventable" readmissions, which may make up as much as 75% of readmissions. Apparently many of them are related to medication: the patient may not have understood the instructions, or doesn't know the warning signs of an adverse reaction, or so on. Infections can also be a problem. In general, patients may not be getting good followup and may not have good alternatives to readmission (this is part of why providing a lot more in-home nurse followup may help).

[Hopes]

That explains why installing nurse practitioners onsite at the nursing homes has decreased readmissions. They are able to identify and treat infections without readmission. Their being there also allows themt o help the nursing staff better understand the medication instructions, etc.

[BrianTH]

Originally Posted by Hopes

That explains why installing nurse practitioners onsite at the nursing homes has decreased readmissions. They are able to identify and treat infections without readmission. Their being there also allows themt o help the nursing staff better understand the medication instructions, etc.

Yep.

Incidentally, one study concluded there could be as much as $12 billion in annual savings available from eliminating preventable readmissions (and that doesn't account for the indirect and non-monetary costs imposed on patients from being forced back into the hospital). So this is a fairly big deal.

[Katarina Witt]

Originally Posted by BrianTH

So the target is "preventable" readmissions, which may make up as much as 75% of readmissions. Apparently many of them are related to medication: the patient may not have understood the instructions, or doesn't know the warning signs of an adverse reaction, or so on. Infections can also be a problem. In general, patients may not be getting good followup and may not have good alternatives to readmission (this is part of why providing a lot more in-home nurse followup may help).

That is a very subjective assessment. Not saying I disagree, but the article did not shed any light on what it considered "preventable" readmissions. I think the philosophy of sending people home from the hosital "quicker and sicker" is responsible for a lot of readmissions.

[BrianTH]

Originally Posted by Katiana

That is a very subjective assessment.

It is certainly a difficult figure to define and measure, although I wouldn't conclude that means it is "subjective".

In any event, the cited source for that 75% figure is the Medicare Payment Advisory Commission, and I believe they were specifically referring to Medicare readmissions. Similarly, the $12 billion in possible savings was from the same source, and also was in reference specifically to Medicare readmissions.

[Katarina Witt]

Originally Posted by BrianTH

It is certainly a difficult figure to define and measure, although I wouldn't conclude that means it is "subjective".

In any event, the cited source for that 75% figure is the Medicare Payment Advisory Commission, and I believe they were specifically referring to Medicare readmissions. Similarly, the $12 billion in possible savings was from the same source, and also was in reference specifically to Medicare readmissions.

It is subjective. The decision to hospitalize can be based on many things other than diagnosis. Does the patient have someone at home who can care for him/her? Can this person be taught how to use some piece of equipment the patient needs? Is the home safe for the patient? Likewise, the decision to rehospitalize can be based on criteria other than diagnosis. Is the patient taking his/her meds properly? Following the prescribe diet? And so forth. When is a second hospitalization a "rehospitalization"? That can be a difficult question to answer, too. Has the patient's condidion worsened? If so, is it a rehospitalization or a new hospitalization for a different condition?

[BrianTH]

Again, just because an issue is complex or difficult doesn't make it "subjective". In this particular case, the issue isn't borderline cases involving a decision whether or not to readmit. Rather, the issue is in what percentage of cases where there is a readmission could the readmission have been prevented with different policies.

[Katarina Witt]

Originally Posted by BrianTH

Again, just because an issue is complex or difficult doesn't make it "subjective". In this particular case, the issue isn't borderline cases involving a decision whether or not to readmit. Rather, the issue is in what percentage of cases where there is a readmission could the readmission have been prevented with different policies.

I'll argue this one with you till kingdom come! I am a health care worker; you are not. The bold is SUBJECTIVE! For one thing, you're dealing with hypotheticals here. No one can say this stuff with any degree of accuracy. I also know how Medicare works, having been employed in several Medicare-certified home health agencies. The people that do these studies never even see the patients.