The Road Paved with Good Intentions
Last week my ADVANCE
colleague, Janey Goude, wrote a piece about the Medicare plan
to charge penalties to hospitals with excessive readmission rates. I had to reluctantly agree with her assessment... the plan isn't working the way it should.
This is one of the problems of public health. The field tries to ensure that the population is protected from harm in many ways, including from hospitals and other health providers. It's one of the reasons we're required to be licensed as professionals. Sometimes those actions have unintended repercussions. The New York Times has an article detailing how this can happen.
Janey pointed out how some institutions have figured out loopholes to work around the readmission, e.g. holding someone for "observation" is not considered a readmission. What about hospitals that serve poorer areas with populations that are sicker? There are hospitals on the Upper East Side of Manhattan that cater to a more educated population with better access to primary care than hospitals in the South Bronx, which is a poorer area with residents less likely to have regular primary care. It's likely that the facilities in the South Bronx will have a higher re-hospitalization rate than the Upper East Side. Why should those facilities treating the poor be penalized for reaching out to these communities? They shouldn't.
The article also points out that hospitals with higher mortality rates may actually receive better marks and fewer penalties. It's tough to readmit someone who is dead.
So we have a rule that was designed to curb abuse of the Medicare system (a noble thing), which the clever have designed a way to work around. The hospitals treating those most ill may be penalized for doing the work they do under the rule. Do I think the rule should be thrown away? No, I saw firsthand the abuse one institution did with unnecessary readmissions. I do think it needs to go back to the shop for an overhaul though.
Janey make note... I freely admit that you are right!