• Reflex: September 29, 2011

    U.S. hospitals, facing new Medicare penalties, show wide room for improvement at reducing readmission rates, reports the Robert Wood Johnson Foundation. “The readmission rate to a hospital is increasingly seen as a marker of a local health care system’s ability to coordinate care for patients across care settings, and readmissions are often a sign of inadequate discharge planning and the lack of effective community-based care. Centers for Medicare & Medicaid Services (CMS) has estimated the cost of avoidable readmissions at more than $17 billion a year. In hopes of decreasing these costs, Medicare plans to reduce payments for readmissions, exposing hospitals to considerable financial risks. In fiscal year 2013, hospitals face a penalty equal to 1 percent of their total Medicare billings if an excessive number of patients are readmitted. The penalty rises to 2 percent in 2014 and 3 percent in 2015.” Aaron’s Comment: I’ve complained before that health care reform has a lot of carrots and too few sticks. This is definitely a stick. We’ll have to see how it plays out.

    Yesterday, the US Government picked the case it wants to appeal to the Supreme Court: the 11th Circuit (Florida) health reform case (brief here), but not the 6th Circuit (Thomas More Law Center) case (brief here), unless the court wants to take them both up together:  “In the federal government’s view, the Court should grant the federal government’s petition in Florida and hold this petition pending a decision in Florida.  Like this case, Florida presents a court of appeals decision analyzing the constitutionality of the minimum coverage provision under both the tax and commerce power, so it provides a vehicle for the Court to address both questions if necessary.” Kevin’s Comment:  The Obama Administration is running to the sounds of battle, refusing to delay the cases with petitions for rehearing en banc* and choosing to appeal the one Court of Appeals case they lost.

          * Rehearing in front of the entire 11th Circuit instead of a 3-judge panel.

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    • Question for advocates of the readmission penalty (no snark intended – seriously):

      Have you ever worked in a hospital setting where a big chunk of the patients come from the underclass? What would happen to Mayo’s readmission rates if you stuck Mayo smack in the middle of a neighborhood that’d been an epicenter of poverty and social dysfunction/despair for decades?

      There’s an immense number of things functions that the personal traits and social network around a married Mormon dental hygenist in SLC performs to keep her from returning out of a hospital that an unmarried, unemployed ex-custodial worker in Roxbury, MA doesn’t have and never will. They can come in equally sick and get exactly the same care, but does anyone believe that they’ll be equally able to look after themselves and equally well looked after once they walk out the door?

      Unless there’s some mechanism that accounts for these differences in a meaningful way this particular “stick” is simply going to mean hospitals like Boston Medical Center – which care for lots of patients who have more in common with the later example – are simply going to get penalized for caring for poor people, who are going to return more often for things that doctors and hospitals can’t do anything about. If this isn’t done carefully it will simply result in fewer resources for the hospitals and patients that need them the most.