Costly Penalties for Repeat (Hospital Patient) Offenders

Posted by in Healthcare


Spending time in the hospital can be traumatic, or just an inconvenience—a chunk of time spent outside your regular life in order to deal with a health situation, get treatment for a chronic illness or just to have a baby. Not many hospital patients, once released, would look forward to the day they can go back. It’s just not the kind of place, no matter how caring and comfortable hospitals try to make it, that you would choose to spend your time.

 

Returning to the hospital is expensive, for patients and hospitals alike. In fact, according to the new provisions of Obamacare, too many readmissions will make it very expensive for hospitals in the way of hefty fines. These provisions, according to a New York Times article, “Hospitals Question Medicare Rules for Readmissions,” are costing hospitals that are spending millions of dollars following up on patients once they leave the hospital to ensure they stay well.

 

The good news, according to federal statistics, is that readmissions are going down. But critics question whether it’s the hospital’s responsibility to act as a watchdog for patients once they leave the hospital. Whose responsibility is it if Aunt Beverly takes her medications or Uncle Roger goes to his follow-up doctor visits? Hospitals are going as far as making appointments, setting up transportation and making phone calls to encourage patients to continue their care after release from the hospital.

 

Treating patients for critical illnesses at a hospital isn’t the same as taking a car in for a 100,000 mile check-up or extensive repairs after a collision. While you may have to take the car back for some minor adjustments after it’s returned, treating illnesses can require readmission for as many reasons as there are types of patients and conditions. Obamacare takes the position that readmissions are the result of poor follow-up care and are demanding hospitals take on the responsibility for not only curing a patient but for keeping him well. 

 

Anyone who has been in hospital for an illness or procedure knows the double-edged sword of being released. You’re happy to be out of the hospital environment and back home to familiar surroundings. But you’re also anxious about leaving the same environment that monitored every aspect of your care—therapy, medications and those pesky checks on your vital signs round the clock. It’s comforting to have an expert caregiver watching over you. Faced with pages of home-care instructions and bottles of medications, it can be confusing and a little scary facing life after release. Hospitals are now being forced to take on the role of home-health provider as well.

 

Some healthcare providers see this as an opportunity to greatly reduce the cost of healthcare. In fact, the article states that nearly two-thirds of hospitals that receive Medicare payments are expected to pay big for unusually high readmission rates for Medicare patients. Hospitals make money treating patients. And hospital care is expensive. No one denies that. But taking more care of patients while they are in the hospital and monitoring them after release may prevent a costly second or third hospital stay.

 

Hospitals will have to weigh the cost of this after-care to the cost of the penalties. Some hospitals may have high readmission rates because they treat more critically ill patients or those from lower socio-economic areas. There is controversy over which measures are most effective in preventing readmissions or ensuring patients take care of themselves once released. 

 

There are so many variables that it’s almost impossible to impose one set of guidelines. Hospital care is, after all, not a “one-size-fits all” type of business. What works for a hospital in sunny Arizona or Florida may not work for one in Detroit’s inner-city. But whatever cuts down on the trauma of readmission and the costs that go with it may be a welcome change for both healthcare providers and patients alike.

 

Photo Source: Morguefile.com

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  • Connie B
    Connie B
    As a nurse of 40 years, I am sad to see what has happened to healthcare.. no, health"business."It is too late to point fingers at anyone, this started YEARS ago and has just snowballed into what we have today. Over-regulation is responsible for most of the cost today and has not been successful in improving care; it has taken the patient out of the process.Regs now dictate who gets what,when.What about the patient? Once the focus of healthcare, they are now just numbers in a recipe for money-making administrations trying to beat the system to stay afloat amongst the regs that have led to 5 or 10 paper-pushers to every 1 nurse  caring for a patient in every healthcare arena. And each new rule shifts resources away from care and towards the business office. Healthcare is like a balloon. Regulations are the hands that squeeze the balloon.Each new reg just displaces the air(money/care), until another reg tries to control that bulge. We are no linger able to recognize the balloon as it should be, and are left to ask, how much more till the balloon bursts?
  • Anne D
    Anne D
    It is true that it is costly for returning to a hospital more than once, also patients are happy to leave but become Leary after such good care& I don't know what more can be done to cure this problem.
  • Teresa C
    Teresa C
    I understand the frustration of trying to set up a primary care physician with a patient upon discharge from the hospital. the response has been, "oh, I'll just go to the ER, that's what my mother did and her mother. Why should I have a doctor?" this seems a cultural thing that needs to be addressed at that level, not a tertiary care facility, but at a primary care site.
  • Anna L
    Anna L
    There are a combination of confounding factors that contribute to a high readmission rate.One of the main obstacles is educational level.  We still have many people who cannot read at more than a third grade level or cannot read and write at all.  Many of these are poor, low income patients and a great majority of those are in their seventies and eighties.I think if we kept patients in the hospital longer and did proper education at a level the patient could understand, a lot of these re-admissions could be avoided.  The cost of keeping them in the hospital longer is probably dead even with the cost of arranging after-hospital care and paying a hefty penalty.We use far too much technology for diagnosis and American consumers have come to expect that American medicine can fix whatever goes wrong with them.It can't.In this age of instant gratification, the quest for a pill to fix what ails you has become even more of a problem.  Why can't you just give me a pill doc?The lack of health insurance caused by the Great Recession has caused many healthcare consumers to try and diagnose themselves, making do with home remedies and OTC medications so serious illnesses often go untreated until they require expensive tertiary care.
  • OSCAR M.B
    OSCAR M.B
    I THINK IT'S TOTALLY UNFAIR TO PENALIZE HOSPITALIST FOR PATIENTS THAT RETURN TO BE READMITTED AFTER FAILING TO COMPLY WITH FOLLOWING WITH THEIR DISCHARGE INSTRUCTIONS. I BELIEVE THAT EACH READMISSION SHOULD BE ADDRESSED ON A ONE ON ONE BASIS, AND THEN DETERMINE WHY IS THAT THE PATIENT IS BACK. IN EUROPE,  THE FAMILY TAKES OVER THE CARE OF THE PATIENT ONCE DISCHARGED...SO, WHY ARE WE NOW FORCING HOSPITALS TO PLAY A "NANNY ROLE" HERE...?TO ME, THE GOVERNMENT IS JUST TRYING TO FIND REASONS, NOT TO PAY TO HOSPITALS AND PHYSICIANS.
  • Tamara m
    Tamara m
    to accountability for ones own self. The hospitals shouldn't be fined for anything unlessits down right negligence.Not the hospitals responsibility to monitor everyone thats impossiblealmost to the extent ofcontrolling or to much in my face I call it.What happened to privacyin this country.Next will have no freedom at all.
  • Pedro V
    Pedro V
    People should be allowed to go the hospital when they need to...to much input from politics, leave that out of the equation ....it does more damage than good.
  • Marcia W
    Marcia W
    I really believe that this was an extremely informative article. With medical facilities providing a variety of care for patients, especially the senior population.  I think the follow-up monitoring  would go a long way once these patients leave the hospital, and returning to life at home would be both a comforting, and a caring approach. And, in turn offsetting future visits for this population. It's always nice to know that someone cares, outside of your family, and friends.
  • Sylvia A
    Sylvia A
    This can be a confusing for many but the only portion of this request from the Obama administration is to ensure that those patients on Medicare are followed-up on after their visit from the hospital. Most Medicare patients are Seniors whose health begins to diminish and would require consistent monitoring. The hospital's part in this is ensuring these patients don't need constant readmission into their hospital rooms because the physicians and nurses didn't do their job right the first time. That's similar to a bad mechanic who just wants the money and finds ways to get you to bring your car back. That's just bad business.
  • Michael T
    Michael T
    This future problem has caused me great concern.  The gov needs to know that people are not widgets. Every human body is different and responds differently. Some heal faster others don't. To fine the Hospital for things that are out of control is wrong. My question is, if the Gov sues does the patient receive the results? If not then this seems to me to be another form of Gov intrusion into Health Care to generate money for the Gov.
  • Mirra N
    Mirra N
    We admit too many patients for 'observation' when they have completely negative test results, we tell them they 'may' be at risk for _ ?When they return and are re-admitted for same symptoms to 'cover our tush' we have now created a co-dependent monster... We do send patients home in some cases prematurely, and should look at their ability to self care or have adequate care when discharged/ but we cannot Make a person who is non compliant take care of themselves or be responsible. In these cases, re-admission is inevitable, and holding the hospital responsible makes no sense...
  • marcia d
    marcia d
    This is ludicrous, many pts don't care , some are too far gone healthwise it's not far to lay the burden on the hospital when the pt should be responsible for their own health. It is bad enough in the hospital one has to enforce the medications but to monitor & follow up. ..crazy.
  • Deborah C
    Deborah C
    As a healthcare Business Manager,it makes sense to follow up on the care of patients after discharge to ensure a sucessful recovery..
  • paula g
    paula g
    I work in a local hospital the practice of readmission has gotten way out of control  an individual had 37 admissions!!!   obviously the physicians had ignored the underlying reasons!!!!   We have to start somewhere to make patient and  physician more accountable!!!!  Obama care is not perfect but it is a step toward taking a severely broken/malfunctioning system and working to change it

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