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eridani

(51,907 posts) Sat Sep 5, 2015, 09:56 PM Sep 2015

Are hospitals driving up costs for people with Medicare to improve quality ratings?

http://justcareusa.org/are-hospitals-driving-up-costs-for-people-with-medicare-to-improve-quality-ratings/

Medicare’s new payment incentive system financially penalizes hospitals with high readmission rates. To meet quality standards imposed by the Centers for Medicare and Medicaid services, some hospitals have been reclassifying patient visits within 30 days after discharge so they do not count as readmissions. They either classify patients as outpatients, on “observational” status, or they admit these patients to the emergency room.

As a result, hospital quality improvement is likely not as significant as the Medicare readmission data would suggest. What’s worse, hospitals that fail to “readmit” patients who have been discharged within 30 days may be penalizing those patients financially. Even if they remain on observational status for several days, they will be ineligible for Medicare skilled nursing or rehab services. (To qualify for Medicare skilled nursing or rehab coverage, patients must be admitted to hospital as inpatients for at least three days in the 30 days prior to getting that care.) And, their out-of-pocket costs could be significantly higher while in hospital.

To support their claims, Himmelstein and Woolhandler reveal that hospital outpatient stays increased 96 percent in the seven years between 2006 and 2013. The rise in outpatient stays represents more than half of the decline in reported hospital readmission rates. There has also been a notable increase in hospital emergency department visits.

6 replies

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Are hospitals driving up costs for people with Medicare to improve quality ratings? (Original Post) eridani Sep 2015 OP

This is what I worry about... haikugal Sep 2015 #1

In my experience, they are pushing hospice, as in, "Never come back!" WinkyDink Sep 2015 #2

healthcare that is based on profit, or revenue, will never work Doctor_J Sep 2015 #3

Medicare penalizes hospitals who readmit patients SheilaT Sep 2015 #4

Our health care system is a corrupt institution at this point. bemildred Sep 2015 #5

People always miss an important point. Igel Sep 2015 #6

haikugal

(6,476 posts)

1. This is what I worry about...

Reply to eridani (Original post)

Sat Sep 5, 2015, 10:06 PM

Sep 2015

Without oversight this is what happens. It's all about the bottom line and to hell with people. Thanks for the OP.

WinkyDink

(51,311 posts)

2. In my experience, they are pushing hospice, as in, "Never come back!"

Reply to eridani (Original post)

Sat Sep 5, 2015, 10:45 PM

Sep 2015

Doctor_J

(36,392 posts)

3. healthcare that is based on profit, or revenue, will never work

Reply to eridani (Original post)

Sat Sep 5, 2015, 10:59 PM

Sep 2015

Our system is pretty much impossible to fix.

SheilaT

(23,156 posts)

4. Medicare penalizes hospitals who readmit patients

Reply to eridani (Original post)

Sun Sep 6, 2015, 01:49 AM

Sep 2015

too soon after discharge, if the readmission is for the same thing.

So it's not the hospitals you need to be blaming, but Medicare. The thing is, a relatively small percentage of patients can account for a very large percentage of admissions. When I was working the information desk at the local hospital, it became very obvious to me who those patients were. I was in no position to make any sort of judgement about their actual medical situation, but it was pretty amazing how I'd see the same names over and over. And that doesn't even count all the uninsured who never got beyond the ER.

bemildred

(90,061 posts)

5. Our health care system is a corrupt institution at this point.

Reply to eridani (Original post)

Sun Sep 6, 2015, 08:30 AM

Sep 2015

Some things ought not be about the money.

Igel

(35,320 posts)

6. People always miss an important point.

Reply to eridani (Original post)

Sun Sep 6, 2015, 09:42 AM

Sep 2015

When circumstances change, people adapt.

You do it. I do it. If we don't like a new policy because it penalizes us for what we're doing or forces us to change our behavior, we find ways to minimize the penalty or minimize the change.

People respond poorly to compulsion.

The response from those issuing the orders and imposing compulsion, seeing their goals thwarted (so they can't say, "Look what I did!" is usually to issue more painstaking orders to make sure that their authority is obeyed.

We hate it when we're the subject of the orders and government authority. We loves it when it doesn't affect us but lets us say, "We built that!"

English has a funny way of dealing with causatives. Some languages have suffixes that mean "cause to"--I don't build a house, I cause it to be built. It gives credit and shows how things happened. Sometimes we fully claim credit, as in "I'm building a house" or "I redid the landscaping" and sometimes we don't, "I'm having the wedding catered". It varies for others. "Did you cut your hair?" and "Did you have your hair cut?" usually mean about the same thing.

I like causatives. It gives commoners an easy way to unmask demogogues. "I saved this species", when uttered by a bureaucrat, is simply false. "I caused others to save this species" might be true, but shows that the bureaucrat's act was one of authority backed by governmental police and taxation powers imposed on others who probably put out the effort and paid the price.

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