Getting Around The Rules: Hospital Readmission Rates

 Stanley
Feld M.D.,FACP, MACE
 

Everybody knows about the
Obama administration’s tricks and cover-ups. Few know what to do about them. Some know what to do. More and more people are seeing right
through the charades. 

In America, unfortunately,
strong vested interest lobbies are effective. I pointed out some of the abuses
of hospital systems lobbies a few weeks ago.

Consumer advocacy
lobbyists do not seem to understand the real issues causing the healthcare
system to be dysfunctional, nor have the money to fight these issues.

Steve Brill’s article in
Time Magazine published hospital retail prices and not the actual prices the
hospital collects. Retail price get the public’s attention. The real issue is
the wholesale prices the government and the healthcare insurance industry pay.
These allowed wholesale prices are also grotesque.

There is a lot of non-transparent
funny business going on behind closed doors with Medicare. It is going to be
accentuated with Obamacare.

Most of us have heard that
hospitals will be responsible for the costs of patient care if the patient is
readmitted to the hospital within 30 days.

This is a very stupid
rule. Sometimes it is the hospital that should be responsible for readmission
because the care was poor, the patient was not ready to be discharged or the
patient had inadequate education about their disease to avoid hospitalization.

The hospital systems’
pressures are to get patients discharged quickly.

My guess is it is the
patient that is responsible for the readmission most of the time.

Many factors could
contribute to a patient’s readmission. They include

1. Not
   following the physician’s post discharge orders.
2. Not
   given appropriate post discharge orders
3. Not
   being taught to become the professor the their disease.
4.  Not participating in adequate follow-up care.
   Follow-up care is important but it has become outrageously expensive.
5. Medicare
   has permitted home healthcare services to charge high prices for simple
   services and procedures that have little impact on patient education and
   avoidance of readmission.
6. Documentation
   by the home healthcare service drives the expensive reimbursement and not the
   value of the care.

The real question is
should the hospital system be responsible for patient irresponsibility?

The answer is clearly no.
The bureaucracy’s answer to the problem is that one size fits all.

Hospital systems are aware
of this defect. Hospital administrators and their lobbyists are working hard to
get around the rule.

Some have figured it out.
They are keeping the patients in the emergency room and charging ER fees that
they can collect rather that putting patients in the hospital and generating
charges they cannot collect.

Hospital systems can
charge patients increasing fees the longer patients stay in the emergency room.

“Medicare does
not count most discharged patients who come to the emergency department (ED)
but are not readmitted, according to a study in Annals
of Emergency Medicine.”

The study
looked at nearly 12,000 discharged patients from Boston Medical Center. Twenty
five percent of the patients discharged from the hospital appeared in the
emergency room in less than 30 days and forty percent of those patients were readmitted
to the hospital.

Hospitals
keeping patients in the ER amounted to a great saving and indeed profit for the
hospital.

Defective
rules and regulations lead to many unintended consequences. No one has tried to
motivate patients to be responsible for not being readmitted to the hospital.

Some
readmissions cannot be avoided. Many readmissions can be avoided.

The main
question would be how to motivate all stakeholders to have incentive to avoid
readmission to the hospital.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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