Between a Rock…and a Readmission


October 8, 2014

**To receive this commentary directly to your email, click the "subscribe to the Health Freedom eNews" button above.


We’re in a hard place. Last year, Obamacare initiated a program to reduce so-called “excess readmissions” in hospitals. Section 3025 requires all hospitals subject to the policy to pay a penalty, called a “payment adjustment,” up to 3% if they readmit too many Medicare patients within 30 days of discharge.

Around 1,400 hospitals are exempt from the policy. But over the next year, 2,610 hospitals –- three-quarters of those subject to the policy -- will be penalized by Obamacare’s “Hospital Readmissions Reduction Program.” They will be paid less for every Medicare patient, not just the readmitted ones.

Penalty payments are increasing. In 2013, 2,225 hospitals paid $227 million in penalties. Over the next year, Medicare expects to extract $428 million in “savings” through reduced payments. To determine penalties, Medicare reviewed hospital readmissions in five categories (heart attack, heart failure, pneumonia, elective hip and knee replacements and lung ailments – two more categories than in 2013).

What does this mean for patients? Hospitals and other concerned parties who opposed the rules chastised the administration for:

·      Penalizing hospitals for what happens during the 30 days patients are not under hospital care.

·      Extrapolating results using medical record data from only 25 patients, potentially leading to inaccurate conclusions.

·      Not excluding from readmission review patients with “extreme conditions” such as organ transplants, end-stage renal disease, burns, psychosis and chemical dependence.

·      Not taking into account socioeconomic conditions of patients (e.g. race, geographic location, occupation, income, lifestyle, language, literacy).

·      Not distinguishing between “related” and “unrelated” readmissions, resulting in penalties if patients are admitted for a condition unrelated to the first condition.

Some commenters worry patients will die. They pointed out death after hospitalization would improve a hospital’s “readmissions” score (p. 53376). In a Comment and Response section of the final 2012 rule federal bureaucrats wrote:

Comment: Several commenters expressed concerns that the Hospital Readmissions Reduction Program may induce unintended consequences of overcrowding hospital emergency departments, as hospitals may believe they are compelled to avoid readmitting patients.

Response: We recognize that performance-based payment penalty or incentive programs may have the potential for unintended consequences. We are committed to monitoring the measures and assessing unintended consequences over time, such as the inappropriate shifting of care, increased patient morbidity and mortality, and other negative unintended consequences for patients. (p. 53376)

Considering the VA debacle, I’m not reassured. At least 40 veterans have died due to the VA’s pay-for-performance incentive program. It took a retired physician to blow the whistle and expose the VA’s “timely treatment” charade.

How will penalties be determined? The 2012 payment rule includes the following two-part “Excess Readmission Ratio Calculation” (p. 53380). Its “risk-adjustment coefficients” and “hospital-specific effect” wizardry will lead to inaccurate “findings.” Bureaucrats admit imprecision: “The method produces an adjusted actual (or “predicted”) number in the numerator and an “expected” number in the denominator.” The bureaucratic chicanery will be difficult to counter.

Patients need patient- and pocketbook-friendly alternatives. Medicare is in crisis because it’s an unsustainable Ponzi scheme. Those receiving Medicare are receiving three times as much in services as they paid in payroll taxes. Medicare has a $43 trillion unfunded liability. Creating meaningless algorithmic machinations to encourage rationing of care is not the answer to Medicare’s woes.

Removing government from health care is. Health care will be more affordable, ethical, charitable, accessible and patient-centered when the bureaucracy, the regulatory and reporting costs, the privacy intrusions, the prescriptive limits on care, the more than 150,000 pages of regulations, and the paperwork requirements are gone. Maybe South Dakota will begin the process.

Planning for an Obamacare-free and a Medicare-free future,

Twila Brase, RN, PHN

President and Co-founder