Stanley Feld M.D., FACP, MACE Menu


A Bureaucratic Thinking Disorder

Stanley Feld M.D.,FACP,MACE

The Hospital Readmissions Reductions Program (HRRP) is an attempt to decrease healthcare costs by curbing hospital readmissions rates. The program was launched in October 2012.

Hospital reimbursement by Medicare could decreased the following year by 1-3% because of hospital readmission   

It is another alphabet soup program that was not well thought out. It cannot work as envisioned because of the many unintended consequences.

Hospital readmissions are very costly. If patients are readmitted within 30 days after discharge the assumption is patients were not treated effectively as an inpatient so that they could stay out of the hospital.  

Therefore hospitals should be penalized until their treatment improves.

There are other reasons for patient readmissions within thirty days of discharge.

  • Patients might be too sick to be completely healed at discharge from the hospital. If a patient remains in the hospital too long for his diagnosis the hospital is also penalized.
  • Patients did not pay attention to the outpatient treatment regime they were given.
  • Patients did not take the medication they were prescribed.
  • Patients were too depressed from their illness to take the medication and comply with follow-up treatment.
  • Patients were not smart enough to understand the instructions given at discharge.

The measurement of all these metrics would be very complicated even though I think patient adherence to treatment regime is the most significant cause of readmission.

The sicker patients are the more likely adherence to outpatient treatment  is a problem.

The Obama administration chose the easiest measurement to make to this complex problem. CMS would withhold 1% of reimbursements in 2012 and 2% in 2013 to hospitals that have too many patient readmissions within 30 days of discharge for three conditions: heart attack, heart failure and pneumonia.

This is foolish thinking.

One cannot measure a outcome using one variable when you have so many confounding variables that are not evaluated.

The results will also yield unintended consequences. One such consequence is the increase in outpatient observational admissions for 48-72 hours.

Medicare will not cover the outpatient observation admission.

In May 2014 I wrote “Seniors Should Be Madder Than Hell About Obamacare And Not Take It Anymore.”

 “It is all about money. It is about the government spending less, the hospital collecting more and the patients getting stuck with the bill.

Government officials realize that Medicare costs are unsustainable. CMS creates rules and regulations to expose Medicare to less liability.

Unfortunately the unintended consequence is that CMS exposes Medicare patients to more liability in the process.”

Once more President Obama lied to seniors.

“People are shocked when they receive the bill. Nobody is required to tell them they’re outpatients.”  

Those patients who have been outpatient observation admissions do not qualify for the rehabilitation benefits.

Patients can be responsible for many thousands of dollars for the first 20 days of rehab (nursing home) services.

 “I just found myself in the middle of a medical situation that made it very clear that "the affordable care act" is neither affordable, nor do they care.” 

In 2014 CMS has increased the maximum fine to 3% and added chronic lung problems and elective hip and knee surgery to the list of conditions.

Hospitals are not taking any chances. They are putting everyone they can on outpatient observation status.

Hospitals are also having problems collecting these non-Medicare covered bills from seniors.

Most seniors simply cannot afford to pay and the stress created is not good for their medical condition either which could result in re-hospitalization.

Seniors are increasingly distrusting the government and President Obama about Medicare changes.

President Obama promised them that Obamacare would not affect Medicare or harm one single senior.

Despite hospitals gaming the system with outpatient observational admissions 2,610 hospitals are facing readmission penalties in 2015.

The 2015 fines and penalties affected about three-quarters of the hospitals subject to the programs. The number of hospitals receiving penalties has increased each year from 2,217 in 2013, 2,225 in 2014 to 2,610 in 2015.

CMS also exempted 1800 hospitals from these penalties.

As more conditions are added more hospitals will be receiving penalties. Hospitals will adjust or go bankrupt. The result will be increased cost, a shortage of hospital beds and a weakened and less effective healthcare system.

Many of these readmissions are not the hospitals’ fault. They are the patients’ and their diseases fault.

These policies are just a fraction of the policies that are creating chaos and havoc in America’s healthcare system. They will lead to the demise of, not the improvement in, a cost effect healthcare system.

President Obama’s policy makers have a bureaucratic thinking disorder.

Part of the reason for this disorder is they do not understand problems in the healthcare systems. Their policies are also getting the healthcare system further and further away from creating a cost effective solution to the healthcare system’s problems.

A market driven system along with a consumer driven system can drive down costs down and create happiness for all the stakeholders involved in the healthcare system except the healthcare insurance industry.

I have presented the steps necessary in this slide presentation entitled The Ideal Future State of the Healthcare system.

Obamacare is forcing the healthcare system to turn into not out of the skid.

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

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