Skip to comments.Medicare fines over hospitals' readmitted patients
Posted on 09/30/2012 4:20:05 PM PDT by Red Steel
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.
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,
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.
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.
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
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Ok, so a person has surgery for whatever reason developed an infection which needs to be treated by say an addition surgery - the hospital gets fined?
This is insane.
WHat a nightmare
It’s not clear why people get readmitted to hospital
They are going to start denying Medicare patients to go back to a hospital.
within 30 days.
They will die on the street.
there will be either a way to pass the fee along to the individual [”re-admit fee”?]
there will be people who suffer while they wait the requisite 30 days to be readmitted. I hope they don’t die.
This is indeed a nightmare.
What will happen is hospitals will keep patients longer than necessary, just to make sure they wont come back or send them to a different hospital.
Once the contaminated finger of government touches anything, the “ROT” begins.
So either people will not be readmitted, and possibly worsen or die...or nervous hospitals will have them stay a lot longer than would reasonably be necessary (although the government has rules about that too).
Either way, the costs (on lives of actual human beings or on the nation’s wallet) will rise. Why not just let doctors do what is best? Oh, right. The government is in charge now.
Ask the British what they think of their government run healthcare. The horror stories are legion. But liberals salivate for it. They are the Party of Death, after all.
The list, Ping
Let me know if you would like to be on or off the ping list
GOVERNMENT RUN HOSPITALS???
FOR OLD PEOPLE ONLY???
"How come there's a funny smell in my shower?", asked the little old lady.
Didn’t Dear Reader complain about extra tests and unneccessary procedures when he was running for the Presidency in 2008?
So, how do you LOWER costs by DEMANDING that hospitals make NO mistakes for fear of additional fines and fees?
Liberalism IS a mental disease!!
Only physicians can admit and discharge a patient. Are they going to be fined for the readmission, too? Nope. Didn’t think so. Until there are financial penalties & rewards that affect the way a doctor’s patients are treated/not treated, the hospitals are just the easy pawn in all of this. Now if a patient develops a problem caused by the hospital staff that results in a readmission, that’s a different story. What about non-compliant patients who don’t do what they’re supposed to do when they get home?
It does not take a rocket scientist to figure out that this is going drive up the cost in more ways than one.
What is even worse as that someone is going to pay for these fines. And that someone will be other patients.
“there will be people who suffer while they wait the requisite 30 days to be readmitted. I hope they dont die.”
Thats probably part of the plan.
Insanity? The fine would be assessed even IF the patient is non-compliant with treatment AFTER leaving the hospital.
It is going to be a nightmare.
Then if they don't convalesce back to self care and independent living, suffer infections or complications, and they need to come back- will the doctors stack them in the corridors as non admissions under observation?
Who pays “hospital fines” anyway?
Why you, the patient, whose costs are again increased in fees to cover govt mandates. MEDICARE patient reimbursement by the gubmint is at dimes on the dollar for care as it is.
Physicians will be reluctant to readmit patients even though they need it. It will cause them to compromise what they know to do is the right thing, and it will result in more deaths.
Isn't that special?
Non-compliance or poor compliance is only part of it. In the hospital the patient has 24 hour care. The lucky ones will have a caring family/spouse or can afford to pay for similar care when they get home. The rest of them will make do with whatever their spouse or famiy can give them....which may well be little to nothing in some or many cases.
It was clear if "he" had been calling the shots, Granny wouldn't have had that surgery and a chance at walking without pain
Not that she ever got to walk again anyway, since we were told she died of :”cancer” the night of his election while convalescing from her hip replacement...? Another very strange story there, and never investigated by the press
A panel of bureocrats sitting in Washington DC will decide what happends to those in Dallas, TExas. Cost/Benefit ratio has taken over the doctor/patient relationship. God help the elderly, infirmed, and ill.
Did they get this idea from Romneycare??? I think not.
Wife’s family just went through hell with this. The doctors were pissed at the family for causing the fine, forced them to put their mother in hospice. Also denied her needed oxygen unless they accepted hospice. The doctor told the children they had to “go along with the program” if they wanted oxygen for their mother. We just had the funeral.
Obama and all leftists are evil.
They did it just killed my MIL this way. There was a reason people were so angry over Obamacare.
I’d like to get the reporter who wrote in this article that Obama is trying to “improve care” and “save taxpayers money” and spit in their lying liberal face.
The take away here is the doctors are not making treatment decisions the mindless federal law is.
Hospital Administrator: Ah, I see you have the machine that goes ‘ping!’. This is my favorite. You see, we lease this back from the company we sold it to - that way it comes under the monthly current budget and not the capital account.
[The doctors and onlookers applaud.]
Hospital Administrator: Thank you, thank you. We try to do our best. Well, do carry on.
The really unfortunate thing is, that won't happen. Hospital reimbursement is being determined by adherence to different metrics, and one of those is readmission rates.
Some eggheads who probably never had squat to do with real medicine, or are openly hostile to the way it is practiced, set this up as a metric.
Hospitals will still try to get the patients discharged in the time frame to limit length of stay, and patients will likely still be readmitted the way they were before, but I think it would be naive to think that the readmission process would not be affected by increased bureaucracy (to try to prevent non-essential readmissions) resulting in indecision and possible delays.
The bottom line (and this is my personal opinion) is that it is going to reduce money paid to hospitals because it will set limits on something that hospitals may not have much control over.
And that is the plan. I am not a physician, and it is indeed possible to take actions that would minimize readmissions, but that well is a limited one. Once you pick the low-hanging fruit you will begin to see fast diminishing returns (you spend X amount of time and money to get to 85% of the solution, then you have to spend Y (a lot more than X) to get up above 90%) and it becomes increasingly difficult to improve, you will not meet the metric, and your reimbursements will be cut.
The government tries to make the claim that it is not an absolute number, but a comparative statistic to other similar types of hospitals and you have to stay in the top tenth to get full reimbursement, but...not everybody can make it in to that percentile.
SOMEONE has to fall outside it, and those that do will lose money. It will make providing healthcare even more expensive for them, and the only way they will survive is to be swallowed up by someone else. Otherwise they will go out of business.
By design, of course. If they go out of business, they can't treat patients, and the remaining available resources in a given locality of physicians, technologists, nurses, beds, appointment times for diagnostic tests such as MRI and CT become even more stretched as patients go to already overburdened facilities for appointments and tests.
Delays occur. Instead of three days to a week for an outpatient MRI, it will be three weeks or even three months until you can get in.
Again, by design. This is called "Rationing", but not in the sense we are usually accustomed to seeing it. It is the way liberals ration things from fuel to food by making the supply go down and price go up.
To me, it is certainly conceivable that patient care will be negatively affected by focusing on a metric that will simply discourage caregivers from giving that care.
“The doctor told the children they had to go along with the program if they wanted oxygen for their mother. We just had the funeral.”
Sue them, NOW.
Just get Obama out of office.
This was a sign I had at a Tea Party rally in Boston a few months ago:
If it is any consolation to you, thers bastards are going to be killed themselves later on down the road by the same insturment[s] that they plan on using on us now. Sorry about your MIL.
I know conservatives don’t like going to lawsuits, but in this case you need to. Those doctors will do the same thing to some other family if they don’t learn a lesson. Make them pay for their crime.
I wish it were only that simple.
Liberals have been furiously opening bureaucratic offices, writing policies, hiring people and generally getting as much entrenched bureaucracy in place before someone figures out how Obamacare can be torn apart.
Even if we did elect someone far more conservative than Romney, liberals have been busy as bees laying concrete foundations and entrenching the pillars. Their plan is to make nearly impossible to rip out the metastatic bureaucracy.
For them to die is the purpose of the rules or plan. People are admitted or readmitted to the hospital because for one reason or another, they need to be. This is merely the first step of getting rid of the elderly and infirm.
I’ve already experienced this crap.
I took care of a dear friend for nearly 6 years. At the age 96 stuff starts happening as your body wears out.
So we regularly had to go to the hospital for various events: UTI, Dehydration, loss of blood due to ulcers, etc.
In the last two years of her very full life, the doctor started getting agitated when we’d bring her in saying “I don’t understand why you keep bringing her in! Let stay in her home so she can pass comfortably?”
I would always reply “You guys haven’t been right in diagnosing her imminent and very present dying just any day. It’s been 4 years since her hip replacement where she survived 6 hip operations and 3 rounds of Vicomiacin Resistant MRSA. SHE IS STILL HERE! SHE NEEDS YOUR HELP AND IT’S JUST A LITTLE. SO LET’S FIX HER UP AND WE’LL GO HOME IN A DAY OR SO”.
(BTW, Vicomiacin Resistant MRSA is a flesh eating disease and generally kills most people half her age and even younger. Stella was indomitable and wasn’t going anywhere yet)
the discussions went like that for two years and I always on the side of life and we have a responsibility to help her.
Besides, she wasn’t dying anytime soon. We traveled all over the West. Trips to Palm Springs, Mexico, Santa Barbara, Carmel, etc.
We’d travel for weeks and she was always fine. She always animated and engaged in conversation and was very much sentient and mentally fine.
So after a wile I started researching why the doctor kept pushing “Paliative Care” and it turns out there are financial considerations from the profit and loss point of view for the hospital.
The DR. had a contractual obligation to push “Palliative Care” and his ability to practice in that hospital was very much at risk if he couldn’t convince patients to “go home and die”.
Seriously, that’s what it was about. This was under Medicare and it will be worse under ObamaCare.
I will post the actual contract obligations, profit and loss considerations, Primary Physician obligations to push patients home, etc.
It’s not hard to find but, I won’t have the time today.
I’ll try to get to it in a week or so.
People need to know what “government care” really looks like.
BTW, the Medicare system denies 50% of all claims and has less coverage than typical insurance which only denies 18% of all claims on average.
That’s why many elderly have supplemental insurance.
“I want Mrs. Beer to pass comfortably, in her home...”
FKR! I get it and what the impact is on his ability to practice in that hospital but, Damnit! She is a real living person.
We put up with that Shit for 5 years and Stella finally passed away last November at the age of 101 and 5 months.
Two months before that we were in Palm Springs and then decided to go to Vegas for a few days. She had a great time and loved the shows we went to.
3 before her passing she spent the weekend at a friends house and she absolutely had a wonderful time.
She was also able to spend time with a dear friend of ours that same weekend.
Steve Wozniak gave her a necklace with two seagulls on it, some 30 years ago.
He loved the story of Johnathan Livingston Seagull and it was the inspiration of how he lives his life.
3 weeks before Stella passed we learned Woz was accepting a painting on behalf of Steve Jobs, who had just passed away shortly before that.
We met Steve in the lobby and he went crazy kissing and hugging Stella. She smiled so beautifully and told him she had something to show him.
He asked what it was and she pulled the necklace with the seagulls out of her blouse.
He recalled when he gave it to her but was touched when she said “I never take it off. Not even the so many times I’ve been in the hospital”.
He turned, smiling and said “Really?”
I said “Oh, Ho, Ho! She goes nuts if she can’t find that thing”.
So he spent the next 30 minutes accepting the painting on behalf of Jobs.
When the ceremony was over it was time for the press to take all their pictures Steve insisted she come up on stage with him.
She spent about 15 minutes on stage with Steve hovering over her in between pictures.
Wish I could find the news about Woz receiving that portrait but I can’t. It later turned into a scandal.
Anyway, Stella was just fine after being told for nearly 5 years to go home and pass in peace in her house.
These doctors don’t know shit. I prayed to my God, the one true God, who sees no others beside him and he always answered my prayers in the most amazing ways.
Stella finally did pass but at 101 and 5 months....It was bound to happen! LOL
I love her and miss her but the medical profession is driven by government dicta, dictate, actuaries and “Standard Care”.
You won’t survive unless you push back and become your own physician and enlist the help of the doctors, nurses, anesthesiologists and bureaucrats.
We did and that’s how you get to live to 101 living the fullest life that many will never experience.
I mean, who spends their 100th year on this planet traveling nearly every 6 weeks to somewhere.
We spent New Years 2011 at the Palazzo in Vegas and watched the fireworks go off at eye level as they were being shot from Treasure Island.
We were laughing and had the best time, especially when the final firework went off like a giant expanding star.
Physicians have a contractual obligation to keep the “census” numbers down or they are at risk of not being able to practice at that hospital.
The end-goal of Obamacare is to destroy healthcare as we know it, and replace it with something that meets the goals of utopian liberals.
Suing a doctor is not going to enable a healthcare provider to avoid the cold mechanisms of Obamacare. It will only cause them to go out of business faster and cause more delays and worse healthcare.
I see what you’re saying, but think of this: After World War II should every German prison guard have been held accountable for his role in the murder of so many people? Yes. (Where they? No.) Being a clog in the Machine, and “I was just following orders” is not an excuse. Every single one of those doctors is morally guilty.
Oooops... (Where they? No.) = WERE they...
/Grammar Nazi insurance tag
In my opinion it isn’t the same type of situation.
Proponents of Obamacare WANT to destroy healthcare to the point it has to be taken over, because it will become financially un-viable.
They WANT it to fail, so it must be saved by the government.
Degrading care to the point care suffers is inherent in Obamacare. You can say that you want to force providers to suffer because they cannot meet unrealistic goals, but I would rather see the unrealistic goals addressed so care can be improved.
LOL...no need to avoid the grammar nazis...anyone who read that post knew what you meant.
What Obamacare seeks to do is to take providers, (hospitals, physicians) and divide them against each other. Divide and conquer. Unless we repeal Obamacare by electing Romney, a republican controlled senate, and retain the house, we are all screwed. Humpty-Dumpty will never be put back together again. What a shame. Of course Obama and the oligarch and their families will get the best of the best care. The rest of us will stand in waiting lines, some will die while waiting, some will simply give up and go away. For America, there will be no good outcome.
Kind of the exact same tactic the unions use against hospitals.