Less Money for your Care!!

Posted by Stephen Weinberg, MD FACC FACP
In October, 2012, Medicare established a program to reduce the frequency of hospital readmissions that occur within 30 days of discharge for 3 illnesses. Hospitals are being financially penalized for readmissions that are more than the predicted by Medicare. 2225 hospitals will be penalized a total of $227M this year. Since this money will  come out of their operating budgets, less money will be available for patient care, your care.
Hospitals caring for the poor were more likely to be penalized than those that did not. 77% of indigent hospitals vs. 36% of non-indigent hospitals are having money withheld. Medicare does not take into account the socioeconomic profile of hospitals. 87% of academic teaching hospitals, which care for a disproportionate number of indigent patients, are being fined. These reductions are in addition to the fact that the hospitals do not get paid for that readmission as well. These institutions typically provide sophisticated  tertiary care services to a large segment of the population and can ill afford reduced reimbursements.
These reductions are in addition to the increased expenditures for social workers, discharge nurses and more intense post hospital care paid for by these hospitals. It should also be noted that the government penalizes hospitals for keeping patients in the hospital longer than predicted. Premature discharge contributes to re-hospitalizations. So if you keep patients too long, you get penalized. If you discharge them prematurely, they have a higher chance of readmission. Seems like perfection is the only answer.
Whose fault is it if the patient cannot afford medications (hospitals often provide drugs for several days at home), appropriate dietary components such as a low salt diet for congestive heart failure, unable to truly understand what it takes to stay well despite extensive written and verbal instructions? Many patients just do not care or cannot comprehend the complexities of their own care.
The % hold back (2% now) will be increasing over the next couple of years and additional diagnoses will be added to the list of readmission penalties.
What is important to know is that the government is withholding significant money from many hospitals. This reduced reimbursement will impact your care!