Preventing re-admissions, or so-called “bounce backs,” is one way for Medicare to cut costs.
Too bad there’s zero economic incentive for most hospitals to do so.
It’s obvious that keeping patients out of the hospital will save money in the long run. Many factors play a role in this, including, appropriate primary care follow-up. But, when hospitals diligently spend money to ensure good post-hospital care, they’re penalized for it.
Consider a Minnesota hospital cited in the article, which spent three-quarters of a million dollars on nurses and tracking equipment, and brought down their re-admission rate for congestive heart failure patients from 1 in 6, to nearly 1 in 25. [corrected, thanks for pointing that out]
Despite practicing better medicine, and saving Medicare $5 million, the hospital lost money on the program, and with fewer returning patients, generated less revenue.
With disincentives like these, it’s no wonder why many hospitals aren’t eager to cut down on re-admissions.
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- Is moral distress preventing doctors and nurses from providing good patient care?
- Why removing the tax breaks for non-profit hospitals could be dangerous
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{ 3 comments }
Medicare and its recent cuts including bundling charges, reimbursement cuts despite rising costs, Not paying for known complications of procedures etc. are not fair at all. All these policies in addition to the one you mentioned in this post are almost against any explainable logic. The only logical point about them is that they save money but promote erratic practices which ultimately adds to cost of healthcare.
The disincentive is a natural result of fee for service medicine. The quicker and more efficiently the patient recovers, the less money you make. Bad care drive out good.
Capitation provides disincentives to providing care at all and especially to life-prolonging care for the chronically ill.
All of which just goes to say that ethics of professionalism–all for the patient–must dominate the heart and mind of the decision makers in any health care system no matter what the payment system or woe to the sick.
Which is also why doctors ought to be in charge. Far too many have been seduced by the group think of some HMO’s or unbridled profit seeking business values in some private systems—but most still put patients over self-interest and the profession is still centered on a nucleus of millenia old Hippocratic professionalism that put back in leadership positions can keep the health care system focused on it’s real mission: all for the patient.
Reality check: hospitalists at many very reputable facilities are told to save money, triage pts and clear the bed. These docs look at pts in snapshot mode! But the elderly & chronically ill cant be triaged w/o us expecting readmits. Hospitalists have told me they WILL NOT contact current treaters bc “that would just muddy the waters.”. And i think Duke in Durham is among the best!
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