AGING AMERICA: Myriad roadblocks to recovery fuel hospital readmissions, geography a factor

  • Article by: LAURAN NEERGAARD , Associated Press
  • Updated: February 10, 2013 - 12:03 PM

WASHINGTON - More than 1 million Americans wind up back in the hospital only weeks after they left for reasons that could have been prevented — a revolving door that for years has seemed impossible to slow.

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regionguyFeb. 10, 1310:04 AM

Certainly hospitals can (and are starting to) do better. But recent data shows that not only "could" the readmits be for different problems, many actually ARE. My experience in two large inner-city hospitals is that much of this readmit problem is due to the fact that we have a horribly fragmented healthcare system (including a screwed-up payment scheme), a social structure that has many people living in relative isolation, an economy that continues to separate further into haves and have-nots, and way too many people who just aren't willing to be responsible for their health. Throwing this all onto hospitals is by itself not going to fix things.

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holmescity49Feb. 10, 1310:39 AM

Let us not forget, Medicare has strict policies that boot you out of the hospitals as quickly as possible, extended stays are not an option unless you're critically ill.

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dlfriesenFeb. 10, 1312:09 PM

holmescity49 ... you are correct. Hospitals are reimbursed under a DRG system ... whereby the hospital (in it's simplest form) receives a flat dollar amount regardles of an inpatient's length of stay. Such an arrangement naturally encourages discharge of the patient to avoid incurring excess costs. Needless to say, many such patients are not prepared for discharge based on Medicare's assessment of how long they should remain in the hospital in the first place. The result ... readmissions. Also, it should go without saying that much of the difference in readmission rates between geographic areas (e.g. Utah vs. The Bronx) simply boils down to lifestyle and personal responsibility. All in all ... a very complex problem.

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test0001Feb. 10, 13 4:46 PM

From my experience as a medical resident, I have to agree with the above comments. Not only does medicare pay $0.50 on the dollar to cover health care costs, they limit payments via DRGs as mentioned above and many payers limit the number of days. As a provider, it was incredibly frustrating to have some bureaucrat with no clinical background and no knowledge of the actual patient look up a diagnosis code in a book and arbitrarily decide how long a patient should be admitted. Now couple that with social issues, and other medical issues like mental illness and dementia that limit patients' ability to care for themselves. If a patient is kept longer to deal with these issues, medicare won't cover the extra days. If they get discharged and come back, medicare won't pay either. I'm not sure just what the government expects providers to do.

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drichmnFeb. 10, 13 5:54 PM

"Medicare has strict policies that boot you out of the hospitals as quickly as possible" .... not just Medicare. All insurers do. And this is not new.

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drichmnFeb. 10, 13 5:56 PM

test0001, as a medical resident I'm sure you're aware that your comments are not just applicable to Medicare. Every insurer operates that way.

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avejoeconFeb. 10, 13 6:36 PM

To me, this might just be a money grab. medicare won't pay to keep them there and if they are readmitted, the hospital gets fined big time. Guess who pays, you and I, thru higher premiums. Thanks again to Obamacare for raising cost for healthcare for us!

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robinjFeb. 10, 13 6:48 PM

i agree with all of the comments regarding medicare and all insurers...just remember- medicare always sets the tone first and the other insurers follow suit.

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mchristiFeb. 10, 1310:28 PM

Hospitals don't get fined if a patient is readmitted, under the Affordable Care Act, hospitals loose reimbursement if their readmittance rates go above a certain amount. You imply that any readmittance leads to a fine. That isn't so. Having said that, that is one aspect of the Affordable Care Act I think is highly problematic. Although it is meant to encourage hospitals to not discharge patiences before they are ready, I fear that it may have the perverse effect of hospitals not providing the care people need because it may push their readmittance rates higher.

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martin64Feb. 11, 13 9:29 AM

Although it is meant to encourage hospitals to not discharge patiences before they are ready, I fear that it may have the perverse effect of hospitals not providing the care people need because it may push their readmittance rates higher. = HUH ?????!!!!!!

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