Cuts to Medicare
Primary tabs
Hospitals in D.C., Va. to lose millions from Medicare
Hospitals in the District and Northern Virginia will lose millions of dollars in Medicare funding over the next year because too many of their patients were readmitted to a hospital within weeks of being released, according to Medicare data and interviews with hospital officials.
Beginning Monday, the hospitals will receive lower reimbursements on Medicare claims filed with the government for each admitted patient. Over the year, the total amount of those reductions will vary from $1.2 million for MedStar Washington Hospital Center in Northwest Washington, the region’s largest private hospital, to about $12,000 for Reston Hospital Center in Virginia. Of 16 hospitals in the District and Northern Virginia, all but three will get paid less.
The penalties do not apply to Maryland hospitals because the state has a unique payment arrangement with Medicare, the federal health program for the elderly and disabled.
What happens if you have a heart attack, are released, and have a stroke two weeks later? Or fall and break your hip?
This was an insane provision.
- DCblogger's blog
- Log in or register to post comments
Comments
I don't think this applies to a heart attack/stroke/broken hip
scenario. The reason for this provision is to try to cut down on hospitals releasing patients too soon, only to see them return a short time later for the same thing or for a problem related to the same thing, like an infection caught at the hospital that the hospital should have spotted before the patient was released.
So, I don't agree that it is an insane provision. If the possibility of losing $$ makes hospitals more careful with patients, more attentive to their recovery and its attendant pitfalls, well, I think that is a good thing.
My friend S who had the massive stroke was hospitalized for
what was referred to as a "mini stroke" on 8/23; he was released on 8/26, a Sunday. The next Sunday he had the massive stroke.
There was a problem with the release orders on that first Sunday. S was told to not take his blood thinners until he had seen his cardiologist. Both S and I heard he should be off the blood thinners for one week. The doctor's order was for two days, with a visit and testing on the Tuesday after his Sunday release. When S didn't make an appt for Tuesday, the dr's office called on Wednesday to insist he come in the next day. However, he had not filled the prescription from that Thursday visit but there might have been some pills remaining in an earlier prescription. So, was there patient error added on to the hospital orders' error?
Should hospital personnel handling the discharge ask the patient to verbalize what he understands to be the directions being given to him, in order to ensure there is good understanding of the orders? Should I have restated what we understood to be the orders? Would it have mattered?
Did that misunderstanding about the orders lead to the next stroke? Should he have been kept in the hospital? He seemed so totally better. Except for, in retrospect, his saying he didn't remember certain things. And fatigue. I thought he was trying to downplay the seriousness of his mini stroke, but, now, I wonder if he really had also experienced some memory area damage.
But, I think that having two such expisodes so close together might be included in this kind of statistic. Of course, I don't know for sure. I do know, however, that acute care hospitals are under heavy pressure to move patients out of their facility to make room for other acute cases.
BTW, S's private for-profit insurance company, with a color in its name, decided on its own that he had met his "objectives" and must be sent to a skilled nursing home for additional therapies. The facility does not have a physiatrist on staff, just one who comes in once a week, so S's progress will not be followed as closely by a rehab doctor. At the rehab hospital he was not allowed to eat alone, as his swallowing is not completely normal yet, but at this facility, if I'm not there he has no one with him for meals. Which makes me extremely nervous, altho' so far he's only had a few coughing episodes from swallowing liquids into his windpipe. There is therapy, but it's less intensive and with fewer hours.
But, it was the insurer's decision, not the rehab hospital's -- altho' they certainly did not fight the insurance company. They explained to me that the insurer said that if he stayed at the rehab hospital, but was recategorized to sub-acute from acute because he could now walk and swallow mechanically ground solids foods and thick tomato juice type liquids, but still has the memory and vision issues, then the insurer would demand that he be sent directly to his home once he left the rehab hospital. No days would be paid for at a care facility with therapy after the rehab hospital stay. The insurer wanted him in a lower cost facility. Immediately.
Does the insurer know something about his prognosis which led them to write him off as not being able to get back to independence, much less work?
His roommate is a man who broke his femur and the bone went through the flesh. After the operations necessary to reset the femur, his muscles were frozen and he could not bend his knee. His leg is swollen, deep reddish, and extremely sore. His insurer, a for-profit insurer offering an HMO under Medicare, says he can go home as is, terrifying his family.
This is his side of the story, but his daughter-in-law confirms the issues. She added that he is having trouble dealing with the pain and finds it hard to do the exercises he's told to do on his own.
What the aging ill and injured are facing is rather scary.
Thanks, jawbone
I wonderered how it was going with your friend.
* * *'
Assholes, all of them. (I wish -- being lambert -- you'd turn this in to a post so I can link to it.)
Because health insurance exchanges are so totally going to solve all this!!