It is no longer enough for hospitals to make patients healthy enough to leave. Now, as part of the Obama administration’s health care overhaul, they are spending millions of dollars to keep those patients from coming back, often acting like personal assistants to help them manage their post-hospital lives.
While federal statistics show the effort is beginning to reduce costly and unnecessary readmissions, a growing number of critics are asking whether the government policy, which penalizes hospitals that have high readmission rates, is unfair. They also are questioning whether hospitals should be responsible for managing the personal lives of patients once they are released — or whether they should focus on other ways to improve care.
“It’s consumed a lot of resources,” said Dr. Michael Henderson, who focuses on quality and patient safety for the Cleveland Clinic, which attributes its relatively high readmission rate to successfully treating a high number of severely ill patients.
Under the new regulations, hospitals face hefty penalties for readmitting patients they have treated, on the theory that many readmissions result from poor follow-up care.
It makes for cheaper and better care in the long run, the thinking goes, to help patients stay healthy than to be forced to readmit them for another costly hospital stay.
So hospitals call patients within 48 hours of discharge to find out how they are feeling. They arrange patients’ follow-up appointments with doctors even before a patient leaves. And they have redoubled their efforts to ensure that patients understand what medicines to take at home.
But hospitals also have taken on responsibilities far outside the medical realm: They are helping patients arrange transportation for follow-up doctor visits, get safe housing or even find a hot meal, all in an effort to keep them healthy.
“There’s a huge opportunity to reduce the cost of medical care by addressing these other things, the social aspects,” said Dr. Samuel Skootsky, chief medical officer of the UCLA Faculty Practice Group and Medical Group.
Medicare, which monitors hospitals’ compliance with the new rules, says nearly two-thirds of hospitals receiving traditional Medicare payments are expected to pay penalties totaling about $300 million in 2013 because too many of their patients were readmitted within 30 days of discharge. Last month, Medicare reported that readmissions had dropped to 17.8 percent by late last year from 19 percent in 2011.
But increasingly, health policy experts and hospital executives say the penalties, which went into effect in October, unfairly target hospitals that treat the sickest patients or those facing the greatest socioeconomic challenges. They say a readmission rate is not a clear measure of the quality of care provided, noting that hospitals with higher mortality rates might also have fewer returning patients.
“Dead patients can’t be readmitted,” Henderson said.
“We’re using a proxy because it’s a convenient proxy — it’s just not a very accurate proxy,” said Dr. Karen Joynt, a health policy expert and co-author of an article in The New England Journal of Medicine this month that was critical of the penalties.
Large academic medical centers and safety-net hospitals are bearing the brunt of the policy, and the authors warn that the penalties could make it even harder for hospitals struggling to care for those patients with the highest needs.
The policy, the article says, “has the potential to exacerbate disparities in care and create disincentives to providing care for patients who are particularly ill or who have complex health needs.”
The penalties, which apply to rates of readmission after hospitalization for heart attacks, pneumonia and heart failure, are calculated at 1 percent of hospital payments but will increase to 3 percent by 2015. Medicare also expects to expand the targeted readmissions to include more kinds of hospitalizations.
Source:mysanantonio.com
