Saturday, July 6, 2013

Should Readmission Penalties Apply Equally to All Hospitals?

By E'Louise Ondash, RN

Calling for accountability from those who provide health care is generally a good thing. After all, if a third party – like the taxpayer – is footing the bill for that care, the third party should have some assurance that funds are being spent properly and effectively.

That’s the idea behind the Affordable Care Act’s hospital readmission penalties.

This legislation encourages hospitals to keep readmission rates low for quality purposes and because readmissions are costly. According to federal data, approximately 1 out of every 5 Medicare beneficiaries returns to the hospital within 30 days of their original visit. This costs taxpayers about $17 billion annually. (In 2012, total Medicare spending was $556 billion.)

So accountability is one way to help decrease costs, but like all rules that are made with good intentions, there are unintended consequences.

Hospitals in underserved and low-income communities are feeling those consequences. They argue that they shouldn’t be held to the same standards as hospitals in wealthier areas.

I think their reasons have merit.

Hospitals that serve poor or nearly poor populations typically have clientele who are considerably less educated than those in higher-income communities. There may be language barriers, lack of transportation, no money for expensive drugs, poor diets, illiteracy and fewer resources for home care. So many things can go wrong once these patients leave the protective wing of the hospital.

There are multiple reasons patients return to hospitals within a month of discharge. Some are avoidable, some are not, and still more are just out of the control of health care providers, especially for those who serve low-income populations. 

Most of the eight hospitals in California on the current penalty list are in low-income communities. The penalty for excessive readmissions is a 1 percent reduction in Medicare payments, but that money, if returned to the hospitals, could be used in constructive ways.

It could be used to hire more discharge and follow-up care nurses – especially those who are bilingual. 

Nurses are largely responsible for discharging patients, a process that can be complicated, lengthy and time-consuming. It can also be fraught with errors, especially when transferring patients from one facility to another. More nurses with smaller workloads could mean fewer errors and omissions, and follow-up nurses could be dispatched into patients’ homes to assess the environments and help patients secure the resources they need for good recoveries. There might even be money for those resources -- gas for the car; cab and bus fare; nutritious food; money for utility bills and other necessitates not covered by insurance.

Taking money away from hospitals that need more resources doesn't make  sense.

What sort of post-hospitalization problems do you see in your hospital/area?

Does your workplace have successful strategies to reduce premature readmissions?

Tell us about them.   

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