Medicare fines over hospitals' readmitted patients


2,200 hospitals face Medicare penalties averaging $125K for patients returning with problems


<cite class="byline vcard" id="yui_3_5_1_20_1349039865726_397">By Ricardo Alonso-Zaldivar, Associated Press | Associated Press – <abbr class="updated" id="yui_3_5_1_20_1349039865726_406" title="2012-09-30T15:49:14Z">5 hrs ago</abbr></cite>



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, 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.

Original Post

These hospitals should get it right the first time a patient with Medicare (or Medicaid) instead of so-called private insurance is admitted.  If there is a high incidence of re-admittance, it must be due to inadequate patient care and treatment in the first place.  


Also, what they are not mentioning is the fact that very often many patients get illnesses and infections while in the hospital that they did not come in with.  For instance, most people don't know that hospitals are no longer required by law to keep rooms and equipment sterile (with the exception of surgical equipment), then the hospitals turn around an act all surprised and as if they don't know why there is so much SARS, etc. spreading in hospitals.  People are also usually unaware of the fact that many complications after hospital stays and surgery is due to negligent or inexperienced doctors making mistakes, on top of the fact that hospitals are not longer kept sterilized.  

They don't call it "corruption" ... but that's exactly what goes on in the health care industry ... between everyone involved, i.e.: the hospitals, insurance co.s, the pharmacies and, yes, even the doctors!!    There's so much fraud and excessive charges, collusion on how to make the most profits ... all done with the goal of providing the least amount of actual health care as is humanly (not even morally) possible!!


And they are ALL in it together. 


But ... it seems that many aspects of the health care bill were specifically written to put an end to a whole bunch of that!!  Insurance companies just mailed out billions in refunds for not spending the money on adequate care.  Now hospitals are having to pay fines.  There's also been a crackdown on those committing Medicare fraud scams ... with hundreds of millions now being saved to be put back into the system.


While I wish that the bill could have DEFINITELY been a LOT better ... I'm beginning to see that parts of it are not so bad, either.  Anything that puts a dent in the health care industry's profits .... is A-OK with me!! 

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