By Mary Johnson
Anyone who has spent time in the hospital knows the feeling of shock at how short the stays have become. Hospitalizations more than a day or two in length are rare. Patients who have surgery, hooked up to IVs and EKG machines one day, are sent home quicker and sicker than ever, with far more complex needs.
Cuts under the 2010 Affordable Care Act to what Medicare pays hospitals, as well as reductions imposed on Medicare due to the 2011 debt limit agreement, along with other changes made over the past decade, are creating pressures to limit the duration of hospital stays to only that which is absolutely necessary. Often Medicare patients are discharged in very fragile health. Those with family and friends ready to step in and provide care are the lucky ones.
While hospitals are getting better at providing written discharge instructions to reduce the number of patients who must return to the hospital, sometimes details are unclear or the plan is unworkable. This is particularly true when the patient is older, has cognitive problems, lives alone or can't afford to pay for extra nursing care or other help. Some 18% of Medicare patients are readmitted within 30 days of a hospitalization as a result of post - discharge complications, according to the Commonwealth Fund.
Medicare recently announced that it is cutting payments to a record 2,610 hospitals because too many patients were readmitted within 30 days. While Medicare needs to ensure that patients receive quality care, TSCL is concerned that Medicare beneficiaries and their families may be negatively impacted by the policy.
Reducing readmissions has been a priority with the Obama Administration, which recently added new categories for penalties, including those with knee and hip replacements and people suffering from chronic lung problems. Experts believe that "safety net" hospitals that serve the lowest-income patients are being unfairly penalized because they tend to be sicker and have less support at home.
TSCL is concerned that the 30-day readmission penalties create a perverse incentive for hospitals not to take chances. Hospitals are increasingly choosing to hold patients in observation, treating them on an outpatient basis, rather than admitting them as an inpatient. Medicare patients wind up paying more out-of-pocket because outpatient services are covered under Medicare Part B, rather than Part A. Usually there are deductibles, and co-insurance for each service and drug that would ordinarily be more generously covered if patients were admitted as an inpatient.
TSCL believes that it's time to revisit the policies for readmissions. Doctors need to have more time to visit patients and plan better care with their families. Have you had any unexpected charges related to hospital stays?
Sources: “Medicare to Reduce Hospital Payments,” Melinda Beck, The Wall Street Journal, October 3, 2014.