Comments on: Obama Budget: Hospitals Should Warrantee Admissions for 30 Days

By: Vince Kuraitis

Vince Kuraitis — Wed, 04 Mar 2009 20:21:37 +0000

Al, for more info on Medicare’s planning process see:

REPORT TO CONGRESS:
Plan to Implement a Medicare Hospital
Value-Based Purchasing Program
November 21,2007

http://www.healthcare.philips.com/phpwc/us/about/reimbursement/assets/docs/medicare_report_hospital_value_based_purchasing.pdf

By: Vince Kuraitis

Vince Kuraitis — Wed, 04 Mar 2009 20:11:22 +0000

Al,

You’re describing what I’d call is a common misperception. I thought the same thing for a long time.

As best as I can determine, regional Medicare payment organizations DO have discretion not to pay hospitals for readmissions occurring under certain circumstances. As a practical matter, however, these policies are highly variable and not in any way a part of national Medicare policy.

Best as I can tell (informally), as a practical matter today very few hospitals actually get dinged by Medicare when a readmission occurs, even though technically the threat is there.

Bottom line: this policy today is governed by informality, discretion, and non-enforcement.

I have never seen a systematic analysis of the current state of policy, but would be interested if anyone can shore more analysis or anecdotes.

By: Al Lewis

Al Lewis — Wed, 04 Mar 2009 18:54:51 +0000

I thought the DRGs already covered same-cause readmissions within 30 days. Is that accurate? I imagine that was easily gamed by changing the discharge Dx the second time.

By: Randy Williams

Randy Williams — Fri, 27 Feb 2009 19:33:40 +0000

A long overdue move in the right direction. While none of the steps outlined by Vince will be easy, several progressive hospitals are well down the road on this approach, and in my opinion, have been rate limited ONLY by the right economic incentive structure.

With that potentially out of the way, the next largest challenge will be getting the “team” to act like a team. Easier for integrated systems, maybe, but not impossible even in a “virtual” delivery network.

By: Vince Kuraitis

Vince Kuraitis — Fri, 27 Feb 2009 18:02:08 +0000

Paula, you’re right — there’s a risk of pendulum swinging too far and encouraging more institutional care.

I bet we’d agree (at least in concept) that the goal is to OPTIMIZE balance of institutional and home care.

Thus, the current hospital DRG payment system is focused on minimizing hospital stay — there is no penalty for avoidable readmisssion; instead there’s a financial reward.

The right financial bundling formula will require tweaking. For a good read, see NHRI/RWFJ reports at http://www.nrhi.org/reports.html .

By: Paula Suter

Paula Suter — Fri, 27 Feb 2009 15:53:46 +0000

While I am in full support of reform changes that align goals throughout the healthcare continuum, I do have some reservations related to bundling hospital monies with home care agency monies to prevent unnecessary re-hospitalizations. Could this lead to patients retained longer in institutional settings promoting more institutional care rather than less?