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Hospital Re-Admissions – This should never be on a pay incentive basis to reduce the numbers

Posted May 09 2009 10:41pm

What is the solution to the problem or is it a problem, or just part of life?  Certainly business intelligence software can be of help to work on the situation to reduce the number of patients re-admitted and hopefully this is addressed with education for both patients and clinicians, but where is the fine line to be image crossed?  The 2 are related, 2 doubt about it. 

In Texas, (see the link below) you can see how this all came to blows with the hospital firing the ER doctors, after asking them to find a way to increase admissions, so we have one big Catch 22 there.  There has to be balance, otherwise the battle will continue, just as balance billing continues to haunt everyone.  There’s a certain number of dollars needed for healthcare and when the line is crossed, healthcare suffers when the budget is not covering the bare bones.  

Hospital Admissions are Down – ER Doctors are Fired – Texas Medical Association

If hospitals are rewarded on a re-admission program, how is this going to work, will patients be turned away once the projected monthly quota let’s say it met?  How does that work.  Guidelines are great and they should be just that, guidelines and not incentives for payment.  The hospitals also have to invest in software to have the algorithms to run as well and many are still on paper. 

Recently at the Senate hearings, both patients and doctors were rejected from the hearings as voices of desperation were beginning to be heard.  Voices of anger and not being able to either provide or get adequate health care. 

Health insurers Come Up with One More Offer – Single Payer Supporters Disrupt the Senate

Hospital admissions should never be put on a payment plan, as the ER Room too is like a box of chocolate too, you never know what you are going to get, in other words who with what condition is going to show up.  

If we had lawmakers that were perhaps maybe a little more involved in their own healthcare to understand some of this, we might be making a little more progress, and again I go back to the hearings in January involving the stimulus money and was shocked to see how little was known, captured right on video for the whole world to see.  Most had not seen an electronic medical records and none knew what a personal health record was, and PHRs are a consumer product that have been around for a couple years now, but nobody seemed to be able to find the time to spend 30-60 image minutes on Google to see a few search results and view a couple pages.

Until our law makers take the time to involve themselves in their own healthcare, as they are preaching to us, they won’t get it and all they can do is focus on dollars.  Education is still the big battle here from the top down. Do we see any law makers talk about their health records, no, as they don’t take the time to educate themselves on consumer products.  

All this creates is :Desperate Hospitals

The Diagnosis – Admit or not to Admit?

I could almost bet that most of those individuals who create the pilot programs who work at Medicare too are NOT personally involved in their own health care either, but just rather work on creating algorithms and formulas for the rest of us to live by.  If they had more of a personal involvement in their own healthcare, we might be seeing things from a different perspective I might guess, as once something becomes personal, the view of how issues are seen tends to change dramatically, so all we are getting now is more Magpie Healthcare.  

Do You Know What Your Doctor Is Talking About – Read up and help stamp out “Magpie Healthcare”

Again, Congress has an inadequate understanding of the value of Health IT as they are not actively involved in their own healthcare. 

U.S. Congress has an inadequate understanding Value of Health IT – HIMMS Opening Session

The Gates Foundation is doing their part to “pay” to have educational processes run on television and ads, again most foundations normally wait until someone donates time, but they are paying for it. 

We just flat out have no role models with healthcare, so how can we expect anyone to create a solution who is not walking the walk and talking the talk, but that’s what we have in Congress, sadly to say for the most part.  BD 

Millions of patients each year leave the hospital only to return within weeks or months for lack of proper follow-up care. One in five Medicare patients, for example, returns to the hospital within 30 days. Over all, readmissions cost the federal government an estimated $17 billion a year. 

But even when hospitals find ways to greatly reduce the return trips, saving money for Medicare and other insurers, their efforts go image unrewarded. In fact, because insurers typically pay hospitals to treat patients — not to keep them away by keeping them healthy — hospitals can actually lose money by providing better care. Empty beds mean lost revenue.

Attuned to the issue, two Senate leaders of the effort to overhaul health care, Max Baucus, Democrat of Montana, and the Charles E. Grassley, Republican of Iowa, recently announced their support for changing the way hospitals are paid, to reward them — instead of punishing them — for reducing the number of patients requiring readmission.

But the reduction has been a losing proposition. Although the effort saved Medicare roughly $5 million a year, Park Nicollet is not paid to provide the follow-up care. Meanwhile, fewer returning hospital patients mean lower revenue for Park Nicollet.

The Obama administration has already discussed reducing Medicare payments to hospitals with the highest readmission rates, and the Senate is discussing bundling payments.

Related Reading:

Pilot Program to Reduce Hospital Readmission Rates from Medicare – 14 Communities

Massachusetts Working on Putting Hospitals and Doctors on a Budget – The HMO Revisited?

Sutter Hospitals and Ingenix working together on Business Intelligence Software
Is This a Case for a New Law – Illegal Algorithms? How Do You Sleep at Night Rockefeller asked the CEO of United Health Care
Texas Joining the Ingenix Inquisition with Introducing Bill for New Penal Codes – Fraud Against Practitioners
Doctors fight balance-billing ban on out-of-network costs to survive
Texas Joining the Ingenix Inquisition with Introducing Bill for New Penal Codes – Fraud Against Practitioners

The AMA and the California Medical Association file legal suit – WellPoint and Ingenix

Hospitals Pay for Reducing Costly Readmissions - NYTimes.com

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