Medicare fines over hospitals' readmitted patients

[dipsydoodle]

Source: Associated Press

WASHINGTON (AP) -- If you or an elderly relative have been hospitalized recently and noticed extra attention when the time came to be discharged, there's more to it than good customer service.

Starting Monday, Medicare will fine hospitals that have too many patients readmitted within 30 days of discharge due to complications. The penalties are part of a broader push under President Barack Obama's health care law to improve quality while also trying to cut costs.

About two-thirds of the hospitals serving Medicare patients, or some 2,200 facilities, will be hit with penalties averaging around $125,000 per facility this coming year, according to government estimates.

Data to assess the penalties have been collected and crunched, and Medicare has shared the results with individual hospitals. Medicare plans to post details online later and people can look up how their community hospitals performed.

Read more: http://hosted.ap.org/dynamic/stories/U/US_MEDICARE_PENALTIES?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2012-09-30-05-02-01

[sendero]

1. It's called the Readmissions Reduction Program..

... and is a good idea. It basically penalizes hospitals that shove patients out the door when they are really not ready.

Doing so is expensive over the longer term, when they have to be readmitted and their condition can easily be worse than whatever put them in the hospital to begin with.

[wordpix]

17. my father was shoved out of J. Hopkins & came back 24 hr. later, died a month later

after more operations Johns Hopkins should never have given. Unfortunately, my stepmother approved the operations and the decisions were out of the grown children's hands. (So much for "death panels&quot .

Supposedly Johns Hopkins is one of the "best" hospitals in the nation, but it's not.

[littlemissmartypants]

2. I love dipsydoodle.

[steve2470]

3. I think this is the regulation, please correct if it's wrong

https://www.federalregister.gov/articles/2011/08/18/2011-19719/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the

[Moosepoop]

16. More specifically, this section of the regulation:

C. Hospital Readmissions Reduction Program


https://www.federalregister.gov/articles/2011/08/18/2011-19719/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the#h-251

[socialindependocrat]

4. Conflict of interest runs rampant

The hospitals and their charges

Insurance companies and denying tests and/or treatment

CEOs and Boards of Directors and salaries

Charges for services, vets, doctors, sale of manufactured goods and the philosophy
"Don't leave any money lying on the table"
Which means - if the customer is pleased with the cost then, you haven't charged enough -

Congress and their salaries, health care and retirement
in fact, congress getting paid at all for the past three years

Government waste because nobody cares (not my money)

Defence spending - You mean, EVERYTHING is necessary?
Give me a break!

All of the stupid little programs that take tax dollars to support
when they belong in the University budget.

How many billions do we just "give" to foreign countries to keep them on our side
Because we are too stupid to negotiate

Phew! But I digress - But they're worth thinking about...

[JDPriestly]

19. And most of that money goes ultimately into paychecks for Americans who want to work.

Computers and high-tech innovations have saved so much work, so much money and cost Americans so many jobs.

With the elimination of each of the wasteful expenditures that you list, tax revenue is also eliminated.

We should focus on eliminating those expenses that bring us no benefit, but many of the things on your list like basic research projects that universities do and some of the money we give to foreign countries in the interest of human welfare and peace, most of the money for medical care, and on and on, brings us great benefits that we could not get from companies that have to make a profit for their investors.

To the extent that cutting costs cuts tax revenues, cutting costs just starts a vicious circle.

What had to be asked is whether our society is better for the cost. And yes, our society is better for many of the items on your list, socialindependocrat.

Just watch, once the government has fined the hospitals for readmissions, doctors will choose to keep patients in the hospital longer. That will raise costs for the government, not lower them.

[magical thyme]

5. I work in a hospital with many Medicare, Medicaid and charity patients

We also have a large number of noncompliant diabetes, alcoholic and drug abuse patients. Plus a lot of tourists and "snowbirds" who we can't follow up on easily.

It doesn't matter how much treatment we give noncompliant patients; if they don't take their meds and/or don't change their behavior, they will be back. I see a disaster in the making for us, myself.

We already lose millions on the Medicare, Medicaid and charity patients. We are losing insured patients because we can no longer make up the difference on them. Along with many other hospitals in our state, we are already owed millions of dollars from our state, are cutting back staff right and left, are closing smaller hospitals in our system, with the remaining staff left being run into the ground with more patients and fewer staff.

We also have a couple of older doctors who insist on running duplicate tests -- eg the old ESR test *plus* the newer CRP test -- that give essentially the same information. They don't "get" that they only need to do one or the other. We also have a couple new, young and insecure doctors that run every test under the sun, eg a double set of (very expensive) blood cultures on everybody who walks into the ER, regardless of the obvious signs and symptoms.

Our lab assistants are so run into the ground that out of 12 of them, we've lost (and not replaced) 4 in the last year due to herniated discs and chronic illness from overwork (12+ hour days bending over patients will do that) and one quitting without notice. How many will they have to break before they realize they are running the experienced ones into the ground faster than they can replace them? It's not only inhumane, it is long term costly in recruiting and training.

Not to mention that their exhaustion and chronic pain leads them to make mistakes, which translates into more running around for the techs, with attendant snowball effect.

[RevRN]

9. I agree, this is NOT a good idea

CMS completely ignores the issue of non-compliance. There is a group of patients who despite the best discharge planning will not comply with discharge instruction. Unless hospitals are going to be given the power to arrest these patients and force compliance CMS shouldn't hold a hospital responsible their actions.

As the majority of discharge plans involve medications you have to factor that in. As the Medicare drug benefit was designed to deliver maximum profit to the pharmaceutical and insurance industry rather than medication to senior citizens there are many holes in it. If a patient cant afford the drugs they are prescribed should the hospital be accountable for our corrupt political system? If so will Medicare reimbursement increase to compensate? No, it is being cut.

I have been in health care for over 30 years and feel that, advancements in technology aside, the care patients received in the past was much better than today. The US has the shortest hospital stays in the developed world. Patients have been thrown out sicker and quicker for too long. The problem is money. Will Medicare reimbursements increase to cover longer stays? Of course not they are being cut.

This policy will put a tremendous strain on non-profit hospitals. The for-profit hospital industry will respond by using traditional and find new ways to avoid this patient demographic. They are great at figuring out ways to dump unprofitable patients.

There are 2 huge problems in our health care system The presence of the parasitic insurance industry which drains the system of billions of dollars while contributing nothing in return and the idea that profit is more important than patient care. The ACO did not address these issues it left them essentially untouched. CMS implementing idiotic policies to fund more corporate welfare are only going to hurt people and make it more difficult to deliver patient care.

[magical thyme]

10. agreed, 100%

And there is a 3rd big problem with our health care system and that is our shitty, shitty American lifestyle that causes so many of the diseases to begin with.

Crappy diet, low in nutrition, high in fat. Crappy air and water. Smoking, drinking and working in excess. Lack of family and community networks breeding isolation, lack of purpose in life and attachment to acquiring stuff as a poor replacement.

I have a good friend in another state who stopped taking his diabetes meds because he couldn't afford them on his minimum wage job. Now he is on disability social security, has cost the state a fortune in medical bills due to complications of diabetes, will never work again and is just slowly going down.

It is type 2 diabetes. What he really needed was a good nutritionist doctor to help him lose the weight, and cure the diabetes. But those kinds of things are available only to the fortunate few who run into the right doctor and can afford them.

[Igel]

13. Not to worry.

If your hospital doesn't meet the requirements, for complying with additional goals set not by law but by a bureaucrat or politician the penalty can be waived.

Think of it as a secular version of a papal indulgence. Pay with obedience and your sins are forgiven in advance.

Or you can think of it as extortion. Pay with obedience and we won't come after you as the law says we should.

[bloomington-lib]

14. this is exactly what I see happening

[Scairp]

26. I agree

I think this sounds like a terrible reg. You cannot force people to take their medication or even get them filled if they don't currently have any insurance coverage. As long as we all have free will to take care of ourselves or not then you can't prevent patients from being readmitted to the hospital.

[dotymed]

6. I went to the website listed in the O P.

I agree that hospitals should be fined for releasing their (especially elderly and disabled, low profit) patients too early. It allows them to concentrate on the higher profit (better insured) people to maximize profits. IMO, profit should have nothing to do with health care.
Reading another article it was plain that our government (and their fervent "war on Drugs" zealotry) was actually increasing profits for Dr.'s, hospitals, etc. by criminalizing refills of "powerful prescriptions" to medicare patients. These "powerful prescriptions" were of course, pain pills. The government demands that new prescriptions, not refills, be required for each pain pill prescribed by physicians.

IMO, that is ridiculous. These elderly and disabled people who are on these medications (often for life) should not be required to pay their physicians each month,for a new prescription for a medicine that improves their quality of life. Many (most) elderly and disabled, medicare recipients need these medicines to function. They have been diagnosed with (often) terminal diseases that require pain relief. To deny these people of pain relief is to guarantee them a quality of life that is a nightmare. Often the medicare recipient cannot afford to go to their physician each month to get prescriptions that they will need for the rest of their lives. This seems to be a law guaranteed to ensure that only monied medicare recipients should have the right to live pain free. The other "powerful prescriptions" that can be very deadly if not monitored closely can be refilled with no problem. Blood thinners that prevent heart attacks and strokes...refills for a year. Yet these medications can cause deadly internal bleeding with minimal, non-professionally observed symptoms. It is the same for many B.P. meds, cancer meds, and most medicines that the infirm take daily. The only difference? The "powerful prescriptions" that can help these people live more pain-free existences seem to be geared toward only the people that can afford monthly Dr. visits just to obtain a prescription.

[greymattermom]

12. I know that personally

My 91 year old mom is doing fine except for osteoporosis. They won't give her any more pain pills for her fractures, but instead are giving her epidurals that don't help and are more expensive.

[valerief]

7. This, of course, sounds like a good idea, but I wonder how many sick people will be

turned away from hospitals because of it. You know, they don't get that "extra care" before leaving the hospital the first time, need to come back in a couple of weeks, and are refused admittance.

Health for profit is killing us.

[mikki35]

8. Treating symptoms does not work

Wayyyyyy back in the 1980s hospitals were introduced to DRGs, which is a way of encoding diseases into numerical form so that Medicare/Medicaid could set a parameter, i.e., how long the patient could be expected to stay in the hospital, which sets a range of payment. At the time, it was obvious that there WAS a problem with ridiculously long hospital stays - it worked, in many, many, many cases, it worked TOO well. People are routinely booted from the hospital to continue rehab-type care at home or come back for daily therapy. It is very common to send people home with post-op wound infections brewing, just not visible yet. The elderly frequently have a bunch of concurrent illnesses that can mask/disguise something new. Or they're taking one medication that masks the onset of something new. Or they're prescribed medication for THIS hospital stay that interacts with medication they 'forgot' to tell their doctor about - as in, going home with scrip for Tylenol #3, but 'forgot' to mention that Doctor B across the state line gave a scrip for Percocets last week. Oops, my bad. Just off the top of my head, I can think of about 27 different reasons for a readmission that had ZERO to do with anything the hospital did or did not do. That is why THIS is just as stupid and ultimately wrong for patients as DRGs were - they save the govt money and do nothing but harm patients. Its yet another attempt at a bureaucratic solution to a human condition - the two very seldom mesh well. And now? What you're gonna find is ENORMOUS pressure on the gatekeepers - ER docs and all the MDs that admit patients - to avoid a readmission within that 30 day 'magic' window they've just created. I'll give you 3 guesses who's gonna bear the pain and risks of that decision whether or not to readmit.

[dixiegrrrrl]

18. Apparently the double script problem is now addressed.

According to my dr. last week when I saw her..she was toting around a lap top and entering all information into it, including sending her prescriptions directly to a pharmacy in it.
She explained to me it was because of the newly implemented "Obamacare" rules. ( she is a republican)
that all medical records now are to be kept in some database,( has no idea where)
and that one of the benefits of the database is a patient cannot go dr. shopping for multiple prescriptions.
She indicated the new system is also making dr.s feel someone is looking over their shoulder about what meds they are prescribing.
She is NOT computer literate...oh dear, I see some problems arising.
But the laptop is available to the nurses in the office, they can easily now lookup information when I call them 3 times to tell them the pharmacy claims they never got the script that was supposedly sent to their computer.

I am not thrilled by having my medical history in some unknown database.

[JDPriestly]

20. I love the fact that when I go to my Kaiser doctor, he reminds me that another doctor in the system

asked me to take a certain test a few weeks ago -- which I did not do.

I like the fact that my doctor knows what other treatments I am getting and why. I think it is great. And your medical information is protected by law. If anyone gets information about you that has your name one it when they should not -- then you may be entitled to legal recourse.

It really makes it easier for your doctor (if you have a good, well-trained doctor) to treat you if he or she can access all of your medical information. It may save your life one day. In fact, if you take a lot of medication or have a lot of medical problems there is a good chance that it will.

[mikki35]

23. Central databank

There is no standardized centralized databank for prescriptions or medical records yet. There may be some in place by your insurance company or by a large hospital group or if you use a certain brand pharmacy retailer or if the scrip is for narcotics - that one is being kept by DEA. I probably should have used a different example since the narcotic one is, for the most part, no longer there. Every pharmacy is required to look up patient's prescription history in DEA database for narcotic usage. My point is, there's still hundreds of medications that interact badly, and a bunch of people have no idea what medications they're taking.

The idea of a central databank for patient information has been kicked around for years - huge risks involved. No one was able to work out the problems to get it started. Example: Applications for life insurance turned down for any one of hundreds of reasons found in your medical records; Example: you will never find a job again because prospective employers have access to your medical records; Example: Your positive HIV status is suddenly being buzzed about everywhere....I think you see my point. Once info is leaked, its impossible to 'put it back.' There are many many professions, jobs, you-name-it out there where the competition is ruthless. Some people will stoop to anything to win - numerous and frequent attempts at tip-toeing through medical records to get some dirt would be almost a certainty. Maybe they've figured out some way to safeguard these records...but I would doubt its security.

[James48]

11. Let's try it

and see if it works to improve health care. If not, we'll know in a year or two.

If it does work, then great.

if it doesn't work, we can adjust.

but we should try.

[daybranch]

15. Implementation

I agree and as we learn what works best for patients we will adjust.

[Smilo]

21. Exactly!

[eilen]

22. Two years ago we started a program

in my hospital-- I was on a team of 3 nurses and we visited every Congestive Heart Failure patient (one of the categories of patients covered in this ruling) admitted. We did intensive education on taking care of yourself with CHF to prevent re-hospitalizations. We did witness many readmissions within 90 days but did decrease the our rate.

Anyway, the reasons for frequent readmissions of CHF patients -- progression of disease--there is a population with advanced disease that really should have been counseled to enter palliative or end of life care. They aren't surgical candidates and not transplant candidates, they already have compromised renal systems and are just not going to get any better no matter what they do and no matter what medications we give them. Their ejection fractions are less than 20%. Those patients should not even count under this rule.

Then there are those who are discharged to rehab/skilled nursing care. They have no opportunity to follow the prescribed management. They cannot weigh themselves and the staff at the snf/rehab facility won't weight them and those facilities feed them salty unhealthy foods. They often come back in a week from from d/c unless they have family who make a big deal about it or who bring them low sodium meals. Many of these people have dementia or are frail elderly.

Then there are the noncompliant ones, the people who don't care, or have psych and substance abuse issues. They also usually have history of many comorbidities and are just tired of having to deal with chronic disease. These people generally refuse homecare follow up which is one of our strategies to monitor discharged patients.

We call people at home after discharge, gave them our cards for them to call us with any questions or problems after discharge. One problem we found was getting them to a follow up appt with their cardiologist within 4 days--it's more like 10 days and it will only get worse because we will be getting more patients but not more doctors as the baby boomer generation retires.

[mikki35]

24. CHF patients

are notorious for readmission - always have been and always will be. There are far too many variables that are completely outside of any medical professional's ability to either predict or avoid. What you've described (the panel of 3 nurses to evaluate these cases) is one of the most common ways hospitals are trying to get a handle on readmissions - identify the ones most prone to unpredictable readmits and try to get a handle on why and how to avoid it. There's absolutely nothing wrong with this, its a big step in the right direction.

But, if word gets out in the general population, I'll let you guess what those 3 nurses recommending palliative or end-of-life hospice-type care is gonna be called. Death panel. As silly as that sounds, I'd bet a bunch of money that would be the first words you'd hear. There are some awesomely ucked-up people in this country - that's all I can say.

[eilen]

27. Their own condition is a death sentence, no death panel needed

What is most important is that Medicare reclassify these patients as palliative care rather than CHF as there is no medical intervention on earth that will prevent their readmission and it is not reasonable to fine hospitals for it.

[King_Klonopin]

25. It's a symptom of the problem

I posted on this subject before --

There aren't enough resources (nurses, available bed space,
and especially FUNDING) to care for the sick in a proper way.

We have a bottom-line focused health care system which
has been pushed to the brink because it is "for-profit" and
NOT universal (i.e. too many players, too many conflicting
interests, too many rules) It functions just like an assembly
line that makes cars. Everything is done as cheaply and quickly
as possible, by as few people as possible, working as
"productively" as possible because the insurance industry
dictates the rules of this game.

Our system has too many conflicts of interests. It has been
"penny wise and pound foolish" for decades -- ever since
the advent of the "managed care" model was contrived
by the insurance companies. It is mismanaged, or over-
managed, and does not put "care" or the patient first. It
puts money first.

It's disgusting. Making hospitals the scapegoat, making them
pay for this dysfunction, is wrong-headed and misses the real
issues. Hospitals are stuck in the middle of trying to make a
losing proposition work, and then receiving the blame when it
ultimately doesn't work.

King Klonopin RN