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Hospitals Throughout Nation Facing Medicare Penalties From Readmissions

Posted Aug 15 2012 2:02pm

Medicare is taking a closer look at all aspects of our health care system that may be raising overall Medicare costs .  Hospital readmissions specifically, could be an indicator of a bigger problem in the system that’s contributing to the rising costs of health care and health insurance.  When patients walk out of the hospital, Medicare advocates want doctors and nurses to do a better job of ensuring they get the care they need from follow-up appointments to prescription refills.  Beginning in October, hospitals who do not meet readmission rate criteria will face a penalty through docked Medicare reimbursement checks.

Jordan Rau, a Kaiser Health News correspondent, says this is an example of tough-love on hospitals.  Medicare wants the entire hospital team to focus on helping patients heal outside of the hospital and reduce the rate of readmissions.  There should be just as much attention on patients in the hospital as patients healing outside of the hospital.  According to Patty B. Wight’s article on MPBN.net, Medicare evaluated approximately 3300 hospitals throughout the nation from 2008 to 2011 and looked at three common ailments affecting Medicare patients.  These conditions included heart failure, heart attack and pneumonia.  They kept track of how often these patients were readmitted into the hospital within a 30 day timeframe.  They then looked at how many of these readmissions could have been avoided through better care.  If they had more than the expected amount then they will face this Medicare penalty.

From the evaluation, Medicare found about 2/3 of hospitals looked at will face a penalty up to 1% reduction in their Medicare reimbursement rates.  This may not sound like a lot, but hospitals rely heavily on these reimbursements to cover major health care costs.  Rau believes this enforcement could ultimately prove to be very effective.  It puts accountability onto the hospital to ensure patients are well taken care of, even at home.  There is much evidence to support that hospitals respond well to financial incentives when compared to other avenues.  Medicare has been measuring readmission rates for years but the numbers haven’t changed substantially.  Once their operations affect their financial bottom line, hospitals start paying better attention.

Scott Rusk, chief medical officer at Mercy Hospital in Portland, Maine works for a hospital that will receive a penalty.  While he doesn’t mind the financial incentive to do better, he wants Medicare to know that hospitals are motivated by more things than just money.  Doctors and nurses care about their patients and don’t want them coming back unnecessarily.  Reducing readmission rates has been a goal at his hospital for a long time and they are continuously implementing changes to ensure their rates drop.

Some critics of this approach question if readmission rate is really such a good measure of hospital quality.  Dr. Ashish Jha, an associate professor of health policy at Harvard points out that sicker, poorer patients without quality access to health care will automatically return to hospitals more often.  So hospitals who cater to these demographics end up getting penalized when it may be out of their hands.  Jha definitely wants hospitals to watch readmission rates, but he believes a much better indication of quality is mortality and infection rates within a hospital.  Medicare is expected to incorporate these factors into hospital quality at some point, but for now the focus is on overall readmission rates.

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