In an effort to reduce hospital admissions among the elderly, Medicare has initiated a penalty program, which started in October of 2012. This program was started to pay hospitals for the quality of their services rather than the number of patients they treat.
Reducing hospital readmission rates has become a priority with U.S. policymakers because they believe that this will not only lower costs, but also improve care provided to the patient during their hospital stay. As part of the Affordable Care Act (ACA), Congress directed the Centers for Medicare and Medicaid Services (CMS) to penalize hospitals with “worse than expected” 30-day readmission rates.
Hospitals in every state but one will be fined $227 million dollars by Medicare in the second round of the government’s campaign to reduce the number of patients readmitted within a month, according to federal records released recently.
“Hospitals are being penalized for discharge patients returning to the hospital too quickly. The assumption is that the patient is being released too early or without adequate post-hospital care management,” said Matt Klinger, chief marketing officer at All Valley Home Care. “Hospitals are reimbursed according to the patient’s DRG (diagnosis and condition) and their health plan’s pre-determined number of covered days. This is known as ‘length of stay.’ ”
Hospitals need to arrange for adequate post-hospital care within the allowed ‘length of stay’ days. An average stay in the hospital is usually three to seven days. Once a patient gets past the covered length of stay days, the hospital starts losing money. The hospital must provide safe discharges and quality transitional care management, usually for 30 to 60 days.
With nonmedical home care, a care manager can be brought in before the discharge. They will conduct a free consultation with a potential client and family to educate them on the available resources to help them stay at home living as independently as possible. Having an in-home caregiver also can prevent unnecessary trips to the emergency room. In most cases, the caregiver will catch the decline in its early stages and arrange for an intervention.
“The caregiver will know if a client is losing weight or falling down,” said Klinger. “Quick detection is a big part in preventing that decline. Another key is getting to the patient before they are discharged from the hospital. All Valley is currently working on garnering contracts with hospitals to take care of newly discharged patients for the first 30 to 60 days to reduce the likelihood of hospital re-admission. In many cases, reducing 30 to 60 day re-admissions is as simple as bringing in a caregiver to help monitor and educate the patient about their disease and dietary needs. All Valley caregivers also help with daily living activities such as bathing, grooming, transportation to appointments, and reminders to take medication.”
Source: utsandiego.com