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Subscribe to RSSWASHINGTON — 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.
As of Monday, Medicare will start fining 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 save taxpayers money.
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 in October, and people can look up how their community hospitals performed by using the agency's "Hospital Compare" website.
It adds up to a new way of doing business for hospitals, and they have scrambled to prepare for well over a year. They are working on ways to improve communication with rehabilitation centers and doctors who follow patients after they're released, as well as connecting individually with patients.
"There is a lot of activity at the hospital level to straighten out our internal processes," said Nancy Foster, vice president for quality and safety at the American Hospital Association. "We are also spreading our wings a little and reaching outside the hospital, to the extent that we can, to make sure patients are getting the ongoing treatment they need."
Still, industry officials say they have misgivings about being held liable for circumstances beyond their control. They also complain that facilities serving low-income people, including many major teaching hospitals, are much more likely to be fined, raising questions of fairness.
"Readmissions are partially within the control of the hospital and partially within the control of others," Foster said.
Consumer advocates say Medicare's nudge to hospitals is long overdue and not nearly stiff enough.
"It's modest, but it's a start," said Dr. John Santa, director of the Consumer Reports Health Ratings Center. "Should we be surprised that industry is objecting? You would expect them to object to anything that changes the status quo."
For the first year, the penalty is capped at 1 percent of a hospital's Medicare payments. The overwhelming majority of penalized facilities will pay less. Also, for now, hospitals are only being measured on three medical conditions: heart attacks, heart failure and pneumonia.
Under the health care law, the penalties gradually will rise until 3 percent of Medicare payments to hospitals are at risk. Medicare is considering holding hospitals accountable on four more measures: joint replacements, stenting, heart bypass and treatment of stroke.
If General Motors and Toyota issue warranties for their vehicles, hospitals should have some similar obligation when a patient gets a new knee or a stent to relieve a blocked artery, Santa contends. "People go to the hospital to get their problem solved, not to have to come back," he said.
Excessive rates of readmission are only part of the problem of high costs and uneven quality in the U.S. health care system. While some estimates put readmission rates as high as 20 percent, a congressional agency says the level of preventable readmissions is much lower. About 12 percent of Medicare beneficiaries who are hospitalized are later readmitted for a potentially preventable problem, said the Medicare Payment Advisory Commission, known as MedPAC.
Foster, the hospital association official, said medication mix-ups account for a big share of problems. Many Medicare beneficiaries are coping with multiple chronic conditions, and it's not unusual for their medication lists to be changed in the hospital. But their doctors outside sometimes don't get the word; other times, the patients themselves don't understand there's been a change.
Another issue is making sure patients go to their required follow-up appointments.
Medicare deputy administrator Jonathan Blum said he thinks hospitals have gotten the message.
"Clearly it's captured their attention," said Blum. "It's galvanized the hospital industry on ways to reduce unnecessary readmissions. It's forced more parts of the health care system to work together to ensure that patients have much smoother transitions."
MedPAC, the congressional advisory group, has produced research findings that back up the industry's assertion that hospitals serving the poor, including major teaching facilities, are more likely to face penalties. But for now, Blum said Medicare is not inclined to grade on the curve.
"We have really tried to address and study this issue," said Blum. "If you look at the data, there are hospitals that serve a low-income patient mix and do very well on these measures. It seems to us that hospitals that serve low-income people can control readmissions very well."
Under Obama's health care overhaul, Medicare is pursuing efforts to try to improve quality and lower costs. They include rewarding hospitals for quality results, and encouraging hospitals, nursing homes and medical practice groups to join in "accountable care organizations." Dozens of pilot programs are under way. The jury is still out on the results.
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This is a bad move. Now we have administrators deciding patient care. Readmissions are not always the fault of the hospital. Under Obamacare look at the rise in healthcare premiums for seniors. Just wait until there's a push to declare people brain dead to harvest their organs. Oh wait, that's already happening. Welcome to Obamacare.
Whoa, turn off the conspiracy theories and read what you just wrote. Obamacare is pushing hospitals to declare people brain dead to harvest their organs? I'm sorry, but where's the evidence for that?
Some people will believe absolutely anything.
The first few sentences still have merit. I agree we need to overhaul the system and focus on pay for performance, but this negative reinforcement will not have the desired effect. This may even create an environment where access to certain healthcare is limited in order to avoid incurring a penalty.
We instead need to provide incentives and information for caregivers to positively influence patient outcomes (via improved diagnostics, cost-effectiveness studies), and motivate patients to comply with treatment regimens and manage chronic diseases. Instead of focusing solely on who pays for the care, it is about time Americans shifted the conversation towards what care (how much, and how effective) we are paying for.
Excuse me, Lybasha. I'm a senior on Medicare. My premiums have not gone up. Please don't make assertions unless you have facts to back them up.
Pay for performance? That's not possible with medical outcomes. Too much of the outcome relies on the patient actually doing what they are told. People don't take their meds, or they abuse their meds... They don't stop smoking/drinking when told... they don't eat right, exercise... It's simple not possible.
So is the hospital supposed to just keep Medicare patients even if they are okay? So how long should a hospital hold someone, that is healthy, when no one can predict the next time they will be sick?
Another article that leaves the reader with MORE questions than information provided! Wouldn't expect anything less from MSNBC....
That's not what the article said. Hosptials should not release patients early just to cut costs. That's the point.
So now the hospital is going to be held responsible whether grandpa forgets to take all of the medicine after he is released or he just decides he feels good so he really doesn't need anymore pills.
Between that and encountering a sick grandchild that passes enough germs to cause a relapse the hospital can't catch a break.
Not every patient that is costing the hospital money needs to be kept extra days to prevent gov't fines.
I have several relatives that receive medicare and their premiums did not go up as high as some would have you believe. The premiums go up every year, and have for the last 30 years or so. Any time the Social Security recipients receive a raise in the Social Security, the premiums for medicare go up. What I gather from this article is that they are trying to stop the sending of patients home that have to be readmitted within 24-48 hours of release. Elderly patients, and patients with breathing problems are sent home after a stay, when the hospital knows full well the patient contracted pneumonia while there, or they send them home with the blood pressure still high with the idea that maybe if we get them out of here it'll go down....not to mention they can put another patient in that bed that has private insurance that pays more. My mother is terminally ill, and she has medicare, and is receiving excellent care through hospice. I have no complaints about how "obamacare" has helped with her medical treatments. Don't believe everything you read or hear, without checking facts first, and also, find someone who has experienced it, instead of someone who has something to gain by the political bs.
This has got to be one of the most idiotic things CMS has ever done.
They are ignoring patient compliance. There is a group of patients who no matter what is done with discharge planning will not follow the prescribed medical regimen. Unless CMS plans to give hospitals the power to arrest these people and force compliance they shouldn't be held responsible for their actions.
Medications usually play a part in most discharge plans. The Medicare drug benefit was designed to deliver maximum profit to the pharmaceutical and insurance industry not affordable medications to seniors. If a patient cant afford medications should the hospital pay for them to make up for our corrupt political system? Will Medicare increase reimbursement to compensate? No they are actually cutting reimbursement.
I have been in healthcare for over 30 years and technological advancements aside people got much better care when I started than today. The US has the shortest hospital stays in the developed world. The payment system created by Medicare and the insurance industry encourages this. Will Medicare be changing this system? Of course not they are doubling down on it with capitation and ACOs. They are just planning on declaring that people will have adequate hospital care without paying for it
This will place a tremendous burden on non-profit hospitals. The for -profit hospital industry will use time honored and find new ways to avoid these patients. They are very good at dumping unprofitable patients on the non-profits.
The actions of Blum and the Obama administration's CMS are irresponsible and will hurt the patients they are supposedly trying to help and lead to long lines for care in the long run.
Rev, I'm not assessing this in the same way you are at all. I'm a former Medicare provider outreach and education consultant (all medicare contractors have education staff that instructs facilities and practitioners in legislative changes to medicare). The medicare program has had ongoing efforts to improve the quality of care but unfortunately, the rates of hospital acquired infections has continuted to rise at an alarming rate. If you actually did your research, you'd find that there are less and less NONPROFIT facilities providing healthcare to the elderly.
I'm sure many of you have noticed elderly patient's being discharged before really being healed enough to go home safely... not to mention the INCREASE in hospital acquired conditions (think MRSA). Hospital as paid by a 'diagnostic related group (DRGs)'... this means one patient who is admitted for a certain condition may only be in the hospital for 3 days, but other patient's admitted with the same/very similar condition,who may REQUIRE a longer recovery and not be discharged for a week or 10 days; regardless the payment is the same to the facility whether the stay is 3 days or 10 days (the assumption is that more patient's will be discharged sooner rather than later, so the reimbursement will average out to make up for patient's who may be more expensive for the facility). Thus, yes!!! some hospitals push out patient's who really shouldn't be discharged yet so they can get another patient in that bed to get another DRG.
IMHO, I'd be thrilled if no health care facility, insurance company, drug company weren't allowed to be for profit (to me it's highly immoral) to reap huge profits from others misery. Last week my father had hip replacement surgery and was discharged despite the FACT that his red blood count is continuing to drop... and the incision site may be 'leaking' subcutaneously. We'll see if he's readmitted. The hospital should NOT receive further monies from CMS due to poor clinical judgement regarding a discharge that may have been premature.
Im not sure you have noticed the inherent contradiction in this statement. The rate of hospital acquired infection is correlated with length of stay--this makes sense--the longer you are exposed to potentially dangerous bacteria the higher your risk of infection
Thus, the move to discharge patients earlier is to prevent hospital acquired infectioin
Not where I live (MA) until the advent of RomneyCare we were essentially free of for profit acute care facilities. Unfortunately a Wall Street hedge fund has decided it can feed off of RomneyCare and bought up large numbers of hospitals.
No Eric glimmerr is right. Throwing patients out sicker and quicker goes back to the onset of DRGs & our last flirtation with capitation. Resistant organisms though they have been around since the late 70s didn't become a widespread problem until later.
No, these are not mutually exclusive reasons...
I have been hospitalized three times in the last 9 months for high blood pressure exacerbated by a brain stem lesion. Two out of those three times, I was back in the hospital within 24 hours. Both times I was re-admitted into the ICU with blood pressure over 200.
In their rush to discharge their medicare patients, I was discharged as soon as my blood pressure dipped into the normal range, even if it was still fluctuating wildly. Hopefully this will encourage hospitals to make sure patients are stable prior to discharge.
You were discharged because of the payment system. The hospital gets a flat fee for your diagnosis. The idea is that they will make money on people who do better to offset the money they loose on sicker patients. The problem is that that real world patient care is rarely this simple. This leads to patients being thrown out sicker and quicker. It also leads to cost shifting creating the iconic $50 Tylenol capsule.
This is nothing more than scapegoating. Hospitals are under tremendous pressure from HMO's to release patients as soon as possible and patients are dying. I have no doubt that these patients were released under pressure before they were ready; hence their return within 30 days. I have seen physician letters questioning the decision of insurance providers refusal to pay for days spent in hospitals. One letter questioned the medical qualifications of these so called medical directors of HMO's who make the decisions and they themselves are under pressure.
We have let private for profit companies take over our healthcare system, do you think they prioritized the quality of care the patients receive. We are speaking of companies who bribe physicians to provide lessor care. Lets villainized the right people. Why is the people of the United States afraid to take on the HMO's. They are killing people. The real cowards though are the physicians of the United States, they have stayed extremely quiet during this coup of our medical system.
Finally, there is no proof that HMO's have saved our country a single nickel in healthcare costs but there is plenty of data that the red tape introduced into our system have increase healthcare costs. Enough red tape and paperwork that if eliminated we could insure the 45 million americans without healthcare insurance, almost all who have jobs that don't provide a healthcare plan. The implications of private industry controlling our healthcare system is tremendous, what next the military? The military is already on the radar for takeover. As americans we must act; we can't trust the medical community to do anything, nor can we trust our politicians, they have already been brought off. The health and safety of our families are at risk and there have been many deaths by premature discharge.
Not only have lives been lost but the money spent providing substandard healthcare has also been lost. Stupidity and greed has replaced common sense. Don't place blame on the hospitals they are being asked to do more with less and less.
Quote from article " About 12 percent of Medicare beneficiaries who are hospitalized are later readmitted for POTENTIALLY preventable problems " , said the Medicare Payment Advisory Commission, also known as MedPAC, key words --- potentially preventible problems. It seems to me that when a person has a health issue that anything can happen at any time and that if you are released from the hospital on one day there are no guarantees as to how soon you might need to return. Therein lies the problem, however, at the same time it cost much $$$$$$$ to stay in the hospital and get well. I recently went to an emergency room, received excellent care, so no complaints in the care I received but one --- the 4 hours of excellent care bill total -- a little over $ 4000 dollars. Granted the doctors and nurses are highly knowledgeable professionals and a God send to many who are deserving to earn a high paying profession. This being said, I agree with Mmm Mmm Beer's posting --- negative reinforcement will not produce the desired effect. But on behalf of the government being involved in health care ( Medicaid -- Medicare ), How does one gain control of run away costs ? People should not go bankrupt to get well and the medical / insurance industry is bankrupting America. How does one determine what is excessive readmissions as every individual is different and, again, agreeing with Mmm Mmm Beer's posting this will almost certainly set up an environment where access to certain health care will be limited to avoid paying a penalty. One has to look at why costs are so high to get at the root of the problem. My opinion / observation besides outright greed, fraud and corruption is doctor malpractice coverage insurance, NOT readmissions . I personally don't know what the fix is for this problem but at the same time I don't think it is to penalize caregivers. To all of us, life is priceless but the reality of life as most know it --- has a dollar limit and unless your very wealthy monetarily speaking, one can only pray for a long healthy life with little health problems.
Our entire healthcare system needs a major overhaul. Costs have long since spiraled out of control. We have Nobel Prize winning economists in the United States and no one has any ideal how to contain this problem. The fact is the healthcare system has been brought off by private industry. Physicians are being paid to not provide premium care, this alone could save billions. One major solution is education and preventive care. This is paramount, all of us have to take responsibility.
In Europe all companies are required to provide a healthcare insurance package to employees. American companies complain that costs will spiral out of control if they are force to. How come costs have not spiraled out of control with these same companies who do business in Europe and America. What is so different about our country?
What I am about to write is going to raise the hairs on the necks of many people but never-the-less the truth. The population of European nations are mono-racial. All nations in the Western World provide universal healthcare but not the United States. Several years ago a drug was produced to address a specific condition of Heart Disease which affected African Americans disproportionately. When this drug was announced in the media some members of our society considered this an outrage. Why? African Americans contribute well over a trillion dollars each year to the U.S. economy and it has been estimated that only 5% of this money comes back into the African American community. Why should any member of our society become angry over the development of this particular pharmacological agent. Why? African Americans don't deserve equal medical treatment; the truth is we don't receive equal medical treatment.
Healthcare is everyone responsibility, by denying Healthcare to 45 million Americans, most whom work and pay taxes is an abomination. As a society we need to take back the Healthcare System, it is obvious we can not expect private industry to do what is right. If anyone needs reminding industry is in the business of making money, not the creation of jobs, not to provide healthcare insurance to the people who really generate the profits, but to make money.
There are several ways in which hospital are being cut reimbursement. Another way is surveys to patients in which hospitals have to have an "excellent" rating to receive the full reimbursement. 70 % of this is medicare is tied to clinical, what the hospitals do.... and the other 30% is your satisfaction in the outcome.
The government knows it has to cut medicare. But they don't want to look like they are cutting it. So they tie these satisfaction score to their payments and because the bar is set so high.....only a few hospitals can achieve this. Then the government can say...not our fault...if the hospital did better in customer service it COULD have gotten the money.
Unfortunately some people can't distinguish bad outcomes with bad service....for example if a post surgery patient is given a liquid diet due to surgery and they are hungry.... all the explanations don't make them happy and it reflect on their perceptions of their care. This goes on and on with unreal expectations that pain will be completely eliminated....people with terrible illness will keep dodging the bullet and survive...
The greater the patients feeling that the "system" owes them the harsher their criticism on these surveys. I guess it makes them feel empowered. But their "opinion" does serve to cut the system that is trying to help. When hospitals cut staff because of reduced funding then it not help to improve services.
Most importantly, it is not a guarantee that a hospital will always be there. Especially in the small communities. When these center close their doors, and you have to drive 90 miles to a large city....see how that satisfy you.