Why Hospital Readmissions Are a Political Issue
Wednesday, October 3rd, 2012
Another piece of Obamacare went into effect on October 1. From now on, hospitals with too many readmissions of Medicare patients will be fined. This should save taxpayers some money and encourage hospitals to provide better care. However, as with everything else involving Medicare, this initiative is being attacked as a big, wasteful government program.
A “readmission” means that a patient discharged from a hospital has to be admitted again within 30 days, especially for something that should have been handled better the first time. The Medicare Payment Advisory Commission estimates that about one in five Medicare patients admitted to a hospital are readmitted. There are estimates that as many as three in four such readmissions are preventable.
In 2010 alone, Medicare readmissions cost taxpayers $17.5 billion. The “Obamacare” initiative is intended initially to reduce that number by at least 20 percent, and perhaps by more in the future.
This program is just one of several Obama Administrative initiatives designed to reduce Medicare costs and keep the program solvent. These savings are included in the money that conservatives claim President Obama is stealing from Medicare to pay for “Obamacare.” It’s more accurate to say that Obamacare provides a lot of cost-saving measures to keep Medicare going. Those who depend on Medicare, especially for treatment of life-threatening illness such as mesothelioma, deserve to know the facts.
What causes preventable readmissions? Along with medical error, the most frequently cited cause is poor follow-up care. A hospital may release a patient who isn’t able to take care of himself and who doesn’t have reliable caretakers. Or, the caretakers are reliable but may not understand how to care for the patient. Sometimes the patient doesn’t follow hospital instructions.
This problem is so widespread — and not just for elderly patients — that there is a new type of medical specialty called a “hospitalist.” A hospitalist is a physician who practices general medicine within a hospital. This means they supervise the care of hospitalized patients whose regular doctors spend most of their time in their own practices, outside the hospital. Part of the role of a hospitalist is to be sure the patient being released is going to get good care.
The maximum fine for excessive readmission is 1% of a hospital’s base Medicare reimbursements for the coming year. This week more than 2,200 hospitals were charged with a total of $280 million in penalties.
Some hospital administrators are complaining that the program will penalize the poorest hospitals that serve low-income patients with fewer post-hospital resources. Medicare says the hospitals being evaluated are risk-adjusted. For example, if a hospital serves more poor or less educated patients than average, the evaluation will cut them some slack.
Nick Gillespie of the libertarian Reason Foundation complains that hospitals will just jack up other costs to pay for the fines. And even if the program does cut costs, it would be only a tiny fraction of Medicare’s budget. But Gillespie’s real gripe is not with the readmissions reduction program but with Medicare itself. “There comes a time when you’ve got to admit that no amount of tweaks to the system will help if the system is the problem,” he writes.
In other words, he wants to scrap Medicare as it is and expect seniors to depend on the private insurance market to take care of them. However, Gillespie doesn’t tell us in which alternative universe that might actually happen.
