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Getting Around The Rules: Hospital Readmission Rates

Posted Apr 21 2013 1:06pm
 Stanley Feld M.D.,FACP, MACE  

Everybody knows about the Obama administration’s tricks and cover-ups. Few know what to do about them. Some know what to do. More and more people are seeing right through the charades. 

In America, unfortunately, strong vested interest lobbies are effective. I pointed out some of the abuses of hospital systems lobbies a few weeks ago.

Consumer advocacy lobbyists do not seem to understand the real issues causing the healthcare system to be dysfunctional, nor have the money to fight these issues.

Steve Brill’s article in Time Magazine published hospital retail prices and not the actual prices the hospital collects. Retail price get the public’s attention. The real issue is the wholesale prices the government and the healthcare insurance industry pay. These allowed wholesale prices are also grotesque.

There is a lot of non-transparent funny business going on behind closed doors with Medicare. It is going to be accentuated with Obamacare.

This is a very stupid rule. Sometimes it is the hospital that should be responsible for readmission because the care was poor, the patient was not ready to be discharged or the patient had inadequate education about their disease to avoid hospitalization.

The hospital systems’ pressures are to get patients discharged quickly.

My guess is it is the patient that is responsible for the readmission most of the time.

Many factors could contribute to a patient’s readmission. They include

  1. Not following the physician’s post discharge orders.
  2. Not given appropriate post discharge orders
  3. Not being taught to become the professor the their disease.
  4.  Not participating in adequate follow-up care. Follow-up care is important but it has become outrageously expensive.
  5. Medicare has permitted home healthcare services to charge high prices for simple services and procedures that have little impact on patient education and avoidance of readmission.
  6. Documentation by the home healthcare service drives the expensive reimbursement and not the value of the care.

The real question is should the hospital system be responsible for patient irresponsibility?

The answer is clearly no. The bureaucracy’s answer to the problem is that one size fits all.

Hospital systems are aware of this defect. Hospital administrators and their lobbyists are working hard to get around the rule.

Some have figured it out. They are keeping the patients in the emergency room and charging ER fees that they can collect rather that putting patients in the hospital and generating charges they cannot collect.

Hospital systems can charge patients increasing fees the longer patients stay in the emergency room.

Medicare does not count most discharged patients who come to the emergency department (ED) but are not readmitted, according to a  study  in Annals of Emergency Medicine.”

The study looked at nearly 12,000 discharged patients from Boston Medical Center. Twenty five percent of the patients discharged from the hospital appeared in the emergency room in less than 30 days and forty percent of those patients were readmitted to the hospital.

Hospitals keeping patients in the ER amounted to a great saving and indeed profit for the hospital.

Defective rules and regulations lead to many unintended consequences. No one has tried to motivate patients to be responsible for not being readmitted to the hospital.

Some readmissions cannot be avoided. Many readmissions can be avoided.

The main question would be how to motivate all stakeholders to have incentive to avoid readmission to the hospital.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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