Half of Hospitals to Be Punished
The results are in and “the Federal government will punish more than half of the nation’s hospitals – a total of 2,597 – for excess readmissions by withholding more than half a billion dollars in Medicare payments over the next year.” The new penalties are based on the rehospitalization rate for patients with six common conditions: heart attacks, heart failure, pneumonia, chronic lung disease, hip and knee replacements, coronary artery bypass graft surgery. I wonder who is going to pay for this? Do the doctors get penalized? How about the administrators? I wish someone actually did a follow up to see what effects these penalties had on the hospital. What do you think?
Want to reduce readmissions for heart failure? Implement a “salt gestapo”, which would go to the patient’s houses and confiscate salty foods. I was a hospice medical director for a few years. I first suggested the visiting nurses do just that on home visits. We settled on getting red electrical tape and taping closed everything salty in the refrigerator, pantry, and spice cupboards. At least the patient or family would feel guilty before cheating on the low salt diet. It seemed to work pretty well.
Hospitals that want to avoid readmissions for heart failure should look for a way to arrange close at-home follow up to see that patients stick (closer) to the diet and medicines that got them better in the hospital.
We really shouldn’t talk about hospital closures or small practice closures as unintended consequences of various government/insurance/ruler initiatives. As best I can tell they are the intended consequences. Have you ever noticed how they never tell you what problem they are trying to fix when they implement them? That is why you can’t demand evidence that it works beforehand, and it’s very hard to prove they fail afterwards. Fail at what? It’s time we realized lack of access to care is the intent of this whole process, or at least lack of access to a professional that has taken an oath to do no harm and can recognize when a system does, or a hospital that understands the needs of its community and the people working there might actually know the patient and their goals. I wouldn’t be surprised if the next step will be changing medical education or admissions to making sure we get great memorizers of guidelines and scales and put less emphasis on the basic science that allows you to understand how a new drug or process or procedure works and what unintended consequences we may be fixing on our updates in two or ten years. Or could someone more aware of that situation tell me if they’ve already done that.
Bridget, of course that very indoctrination is already being introduced in med schools and cemented in residency. Just as it was for you and I, the industry welcomes the self-selected who can follow orders – only now those orders are aggressively from the government, and not science-based mentors. I quit training med students because this is such a dishonest industry that I’ll never again encourage anyone into it.
Even a government mathematician can figure out that half of hospitals are below the median and close to half are below the mean. If we keep punishing half of the hospitals, we will eventually have very few left–kind of like half life of a drug or radioisotope. At that time we can expect the various busybodies to cry, “What happened?”
I agree, Thomas
And also:
3) The big corporate and government healthcare institutions need a scapegoat for the decline in healthcare. It’s from industrializing the whole enterprise, but they need to blame it on the doctors and hospitals. The press has been pumping how dangerous hospitals and doctors are. It helps if they can “fail” half of the hospitals caring for patients, and “punish” them. Keeps the heat off the culprits.
This is the Obama administration’s goal- to punish hospitals/ providers. They see us as the enemy, and anything they can do to “lower the cost” of healthcare is a “positive outcome”. Even if it means withholding payments due to health care they deem to be “below the standard of care”, increasing the scope of practice of “extenders” (NP, PA, etc.), etc. It’s a brave new world!
Two great truths:
1) The government is looking for any excuse for not paying
2) Hospitals will screen out and avoid treating those patients most in need of care.