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Medicare Fines Hospitals for Too Many Re-Admitted Patients
Posted: Oct 1, 2012
Is this how Obamacare is going to "pay for itself?" What about those complications that are not the hospital's fault? How are they going to rate which complications are due to hospital care and which are due to patient noncompliance? I would think this is a really tough decision to make.
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WASHINGTONIf 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.
....For the first year, the penalty is capped at 1 percent of a hospital's Medicare payments. The overwhelming majority of penalized facilities will pay less. Also, for now, hospitals are only being measured on three medical conditions: heart attacks, heart failure and pneumonia.
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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it's about time - ctmt
[ In Reply To ..]Medicare has been reimbursing hospitals for decades without regard for patient outcomes and quality assurance.
Your concerns about patient compliance are without merit, as the operative criteria will have to focus on the patient's condition at the time of discharge. Many patients are discharged in a less-than-satisfactory condition; this is entirely reprehensible and very unnecessary.
For a hospital (or any healthcare provider) to be approved to accept Medicare reimbursement, they have to comply with a specific set of guidelines and meet defined standards. Nothing wrong with taking the money back if that contract is broken.
It should be noted that Medicare has always had the right - and they frequently exericse it - to demand paybacks from healthcare providers if these providers have billed incorrectly, inappropriately, or have not met census requirements.
Yes! The practice over the past 30 years....sm - VTMT
[ In Reply To ..]has been for hospitals to get them in and out as quickly as possible. Surgeries where patients used to be hospitalized for a week to 10 days are now done as an outpatient, new mothers sent home the same day they deliver, elderly patients with chronic diseases sent home with little or no support. This is a good thing.
Real life recent case story - see message
[ In Reply To ..]My father-in-law was recently in the hospital for a procedure where it was stated "1 to 2 day stay". They sent him home. In hindsight, I thought my sister-in-law and MIL were more on the ball regarding after care. After 3 days of suffering obvious symptoms of infection (they told me he was just tired--that he is sensitive to the anesthesia), they finally brought him back to hospital. He ended up being in Intensive Care for 2 weeks, coded once, and now is in a nursing home. Somewhere in the discharge planning the ball was dropped--whether he should have had some skilled home care, better discharge instructions or what, but that 2 day stay should not have ended up as 2 weeks in intensive care plus rehab.
Awful.. same here. Grandmother needed feeding tube - and was discharged to nursing home the next day!!
[ In Reply To ..]The home even said it was too soon. My grandmother had a bad reaction to the tube, nursing home not prepared to deal with it, and she died before the hospital could help. This is what will continue to happen... its life and death, people! Wake up !
The sad part of it is, is that a lot of the - time hospitals
[ In Reply To ..]are pretty much forced to discharge a patient from the insurance. If you have ever worked in a hospital in the clinical respect, you would see how that Medicare and other insurances tie the hands of the hospitals so many times, and now, it seems as though they want to tell you that you must discharge a patient after a certain amount of time because it is not medically necessary for them to be there but then are going to come back and take money back from them.
Hospitals want patients in their facility. They don't get them in and out as quickly as possible because they want to necessarily. I seriously have seen a patient's admission be denied for a pulmonary embolism because the insurance said it should have been only a 24-hour observation. Then, to think that they could come back in and penalize a hospital with those sorts of standards is crazy.
I was hoping this would come up... - ctmt
[ In Reply To ..]The only way in which the hospital's hands are tied is with respect to the diagnosis they are treating. Far too often, once the patient's status is improved, they are placed on the discharge track. This does not mean their status is optimal for discharge. It simply means the diagnosis for which the patient was admitted has been appropriately treated. Sometimes it just takes a clinician whose head is screwed on to realize there are other diagnoses that can and should be brought to bear.
If you have worked in a hospital in the clinical respsect, you should be all too familiar with the kind of compartmentalized care patients get. All too often, Surgery prepares to discharge a patient when the scope of the surgical treatment plan has been completed - without regard to other diagnoses that would legitimize and necessitate a longer stay.
Add to this the lack of communication between specialists, power struggles between doctors and administration, and failures in discharge planning, and we have an extremely inefficient and sometimes ineffective hospital system that fails to meet the needs of its community.
It's true that insurances place restrictions on care, but it is up to the clinical and administrative staff to pursue the documentation and coding appropriate to each case in order to optimize patient success rates.
Health Insurance - Gerri
[ In Reply To ..]I agree sometimes patients are discharged when they should stay a few days longer. My husband was discharged with his left arm swollen to almost double its size. I asked the doc if he was going to discharge him with his arm so swollen. He said since he was going to a rehab place, he could get the swelling down by exercise. That did not work. He had to be readmitted within a week, and was in ICU and passed away in ICU. He obviously was very ill and needed to remain in the hospital a while longer, but insurance wants the patients discharged after about 96 hours, if at all possible.
I'm so sorry - nm
[ In Reply To ..]
I'm very sorry for your loss. You must have been - sm
[ In Reply To ..]devastated when that happened. Thank you for sharing your experience.
Death resulting from negligence is especially difficult. - This must have been very hard for you. NM
[ In Reply To ..]x
Lil bit of this, lil bit of that.... - SK1
[ In Reply To ..]I'm sure there are times that hospitals readmit patients who could be treated on an outpatient basis. I think for a long time a lot of doctors/hospitals have practiced cover-your-butt medicine and it's easier to readmit a patient than have to explain later why you didn't, should something happen.
On the other hand, if I understood the process correctly, hospitals will also have to be more proactive about making sure patients receive ongoing outpatient followup. Especially in the geriatric population, that's not always easy. The elderly don't always understand discharge instructions, have to rely on caregivers and can be just downright cantankerous about being told what to do. It puts a lot of responsibility on the hospital that may not be easy to follow through on. The patient has to be responsible for their own continuing care.
I wouldn't want to be the one having to determine whether a readmission was justifiable.
This is why there are now closer....sm - VTMT
[ In Reply To ..]partnerships between hospitals and home health agencies affording better continuity of care.
I would think hospitals will have to be categorized. - Those tending impoverished and elderly
[ In Reply To ..]communities will inevitably see more returns than ones serving an upscale, well insured clientele, no matter how good a job they do.
shedding light on standard of care issues - ctmt
[ In Reply To ..]Impoverished and elderly communities do not have the voice or visibility enjoyed by upscale, well-insured clientele. It's time we level the playing field and demand accountability for all citizens.
I'm hoping this means clinicians will really have to wash - their hands. They kill a lot of patients.NM
[ In Reply To ..]x
You have to admit, a tough QC/QA motivates improvement. - sm
[ In Reply To ..]Hits you in the pocketbook.
The sad part is... - me
[ In Reply To ..]Patient's insurance companies determine how long their length of stay is. I worked for the director of finance at a local hospital years ago and that is why so many are readmitted within a short period of time. Why does an insurance company regulate what a physician, who has years of training and experience (usually) determine what is appropriate for a patient to remain in the hospital? Not everyone heals or recovers at the same pace. That is where we fell into a hell hole - and it has only gotten worse.
that's not the sad part... - ctmt
[ In Reply To ..]The insurance company determines length of stay based on diagnosis. It is up to the physician to reasses and refine patient diagnoses to optimize care.
The sad part is the lack of understanding on the part of physicians, combined with lack of coordination with administration and finance, that consigns so many patients to be treated unsatisfactorily and discharged prematurely.
Simple example: How many of us have seen Medicare denials for "rule-out" studies? Doctors often fail to appreciate the difference between a "reason" and an "indication". Undertrained staff allow these errors to go unchecked, leading to reimbursement fails, and patient-care fails.
I couldn't get an echocardiogram for my mother to save my life (or hers) because nitwit attendings couldn't think their way out of the box. I could have handed them the code. Their heads were inextractable from their nether regions.
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