Medicare Re-Admissions Penalties–Algorithms Keep Money Shifting and Make It Difficult for Realistic Budgets to be Met Alon
Posted Aug 14 2012 11:25am
In healthcare today we see a lot of this going on with standards and goals that are to be met and there are great efforts out there but again we come back to shifting more money away from hospitals and what’s being accomplished here other than one more analytics system that becomes counter active at times with patient care? I agree it’s good to have goals and work towards them but we are reaching a tipping point here where all we are doing is shifting money and creating news stories for the most part.
First of all demographics and the types of patients cared for has a lot to do with how the numbers will roll out. In addition technology does contribute and does help but probably not at the pace that HHS is forecasting either. Some of the best accredited hospitals are getting fined, so what’s up with that? You also have to remember that the admissions goals and formulas were created a few years ago so with technology moving so fast today and with the lack of business intelligence with most governmental agencies to function and compare with private companies, it’s outdated. It’s just one more thing for hospitals to deal with and like I said, good to have goals but all this does is shift money for the most part. Some hospitals for their efforts with time and money spent have been on the short end of this too, so concerted efforts don’t make much difference, it’s luck of the draw for the most part with the demographics of patients and the type of care given. You can see from the post below to where UCLA was given a grant to study how remote monitoring can help and it will to some degree but until all hospitals are using systems with some type of common “data” and “software” values, what does it do?
In the meantime just shift more money around as today we are finding a lot of good methodologies for better care but ending up in the bean counter analytics is turning in to a big black hole. I said a while back that rating hospitals is useless anymore as the data is so flawed so what makes this report any better? Same applies for the doctor ratings and I just wrote to a doctor this week who is retired and told him on the web he’s still listed as seeing new patients, and he’s been retired for about 6 years not.
The one story that gets me though is the Heritage Foundation and their search for the perfect re-admissions algorithm..look at the site full of gamers crunching numbers…I find humor in this as well with seeing former HHS director sucked in here too but he also has his PE firm to make money too so keep that in mind…Go take a look at the site and see how it is set up to game and crunch numbers…is anyone going to win that $3 million dollar prize…it’s just like the WellPoint XPrize $10 million dollar prize they put out to solve healthcare a few years ago, you get a lot of PR out of it but in reality the problem is bigger than million dollar carrots can solve. See how the public and executives get sucked in here with naïve beliefs that an algorithm can solve “all” problems?
With current day complexities today, setting and meeting some goals are pretty much futile so what’s the next step here? Are we headed for a new algorithm that says “no” if the patient needs to be readmitted?With some of the data we work with today and where intelligence is added to “flawed” data, that’s about the end of the rope and look at all the time and money it costs to shift money as hospitals get fined, and then some contest, and then we go to lawsuits…so is this working? Looks pretty futile and outdated to me.
So keep shifting that money around…..and create some big profits for the analytics folks who are ready to sell you truckloads of software to support the effort…some of it is truly helpful but sifting through and dumping the garbage part of software analytics today is a chore. BD
Medicare is cracking down on hospital readmissions in a way that is going to hurt the bottom line of facilities in most parts of the nation.
Come October, 2,211 hospitals will have their Medicare readmissions reduced by as much as 1 percent, records show . It's part of a new effort , authorized by the Affordable Care Act, to get hospitals to pay more attention to ensuring that patients receive the care they need after they leave. Nearly 1 in 5 Medicare beneficiaries is readmitted within a month.
Among the hospitals getting penalized are many big names, including Mount Sinai Hospital and New York-Presbyterian Hospital in Manhattan, the University of Michigan Health System in Ann Arbor and Yale-New Haven Hospital in Connecticut. (There's a bit of irony in that last one, as Yale researchers helped Medicare measure readmissions.)
Massachusetts General Hospital, just lauded as the best hospital in the country by U.S. News, will lose one half a percent of Medicare payments for each admitted patient. A total of 278 hospitals are getting the maximum penalty. You can look up your hospital here .