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What’s Going to Happen to Patients When in October of 2012 Medicare Will No Longer Reimburse for a Hospital Readmission Wi

Posted Apr 08 2011 6:11pm

This is a very good question and explains too why we see all these big bounties hanging out there for coders to solve the problem with some algorithms.  Granted there’s tons of room for improvement, home monitoring and many other technology advances that can be used to keep re-admissions down.  But what if you are that patient that gets everything in the way of technology, home monitoring and the whole works, maybe several thousand dollars worth of technology and you end up getting sick again, and need to go back, due to no fault of yours or your medical care?  How is this hard core rule going to play out for those with heart failure and acute Myocardial infarctionIs the cardiologist going to be the dirty dog for a scape goat if your body decides to do otherwise? 

Sometimes the absolute best care can be given and the body says I’m having another attack 2 weeks or so later?  What happens then if the patient has already been there?  Do you start keeping patients for 30 days, of course not but on the other hand who’s going to be the one that says to the patient, you can’t come back as we don’t get paid.  Your heart attack is your fault.  Again, I see the room for improvement, more home monitoring, etc. but how this rule be cut and dry?  We know there’s a lot of money involved here as even former HHS director Leavitt has joined the board of a healthcare finance service, so everywhere you look you might be told good care is at the heart of all of this but dollars still seem to speak a different story.  He’s right in there promoting this code bounty too. 

Former HHS Secretary Mike Leavitt Joins Board of Healthcare Financial Services Company

I guess over the next year we may be hearing more about this as the time gets closer.  What business intelligence was used to make this decision? Could a patient be admitted to another hospital then?  So far we have seen pay for performance efforts not improving quality care either, so perhaps before this becomes law there could be some more questions to answer as again we delve deep into the area of “unintentional consequences” which happens a lot today without some type of business intelligence to at least model it before making decisions.  Second of all the algorithms will help, but wont completely solve re-admissions.  BD 

NEW ORLEANS—As the feds and payors focus on curbing readmission rates, hospitals and caregivers need to revisit management of the hospital-to-home transition. Philips Healthcare shared a new multi-vendor, multi-disciplinary model during the annual meeting of the American College of Cardiology (ACC).
“Patients leaving the hospital do not want to return anytime soon, yet many find themselves back in the hospital within 30 days. It has been shown that better patient outcomes are a result of not only the care received while in the hospital, but also the care at home,” said Henry A. Solomon, MD, chief medical officer at the ACC.

Post-discharge, Maria’s plan included home telehealth monitoring and remote cardiac monitoring managed by a centralized telehealth center. Physicians prescribed a Holter monitor, PT/INR meter and home defibrillator. She also used the automated dispensing service, which was programmed to alert providers if she missed a dose. Finally, Maria was enrolled in an ambulatory quality improvement registry.
Providers stressed that a comprehensive model that weds education, multidisciplinary management and consistency and standardization is key to addressing the readmission challenge.


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