Medicare patients today, everybody tomorrow.  Obama Seeks to Reduce Costs by Limiting Medicare Reimbursements for Hospital Readmissions

In a cost-saving measure tied to the proposed expansion of health care, the Obama administration is seeking to reduce hospital readmission rates by rewarding or penalizing hospitals through Medicare payments.

Proponents say this will force hospitals to do a better job of follow-up care, follow a more responsible discharge policy and promote better preventive measures. Opponents of the plan think it would, along with other proposed measures, result in the rationing of health care.

Do these people really think healthcare professionals don’t give a damn about their patients?  As a former cardiac nurse and occasional hospital patient, I’m here to tell you that’s not true.  Discharge planning is extensive and comprehensive.  Instructions are given about medications, followup, home healthcare and physical therapy arrangements if needed, and other things, depending on the situation.  Anyone who has a family member who’s been hospitalized or has experienced it themselves can tell you that.  I’m not saying mistakes aren’t made, or that quality of care is uniformly high in every facility, but to assume an entire industry is guilty on that basis, as proponents imply, is just wrong.

Almost one-in-five hospitalizations of Medicare beneficiaries results from readmissions of patients who were discharged from the hospital in the last 30 days, according to the White House.

“Sometimes the readmission could not have been prevented, but many of these readmissions are avoidable with better discharge planning and follow-up care,” said a White House fact sheet.

And who are Medicare patients?  People over 65, those most likely to suffer failures in health.  It’s called aging, a sad fact of life.  Often new or undiagnosed conditions appear during a hospitalization.  Haven’t you noticed that it seems once something goes wrong with the body, other things do, too?  And some bureaucrat is going to decide whether your re-hospitalization is “valid?”  Based on what?  His crystal ball?

“To improve this situation, hospitals will receive bundled payments that cover not just hospitalization, but care for 30 days after the hospitalization. Hospitals with high rates of readmission will be paid less [through Medicare] if patients are readmitted to the hospital within the same 30-day period.”

So they’ll pay hospitals less.  Do you know how hospitals rein in costs?  They cut staff, among other things.  Less staff equals fewer admissions.  Do the math.

The one-size-must-fit-all approach to limiting readmission payment ignores a key element:  patient behavior.

Most hospital readmissions are not under the control of the hospital, said Edward Hannon, CEO of McDowell Hospital in Marion, North Carolina, and chairman of the American Hospital Association (AHA) Small or Rural Hospital Governing Council.

“Most are the result of a complex series of conversations, circumstances, and medical decisions that involve hospitals, physicians and other providers who manage patients’ care, as well as patients and their families,” Hannon told the House Small Business Committee in March.

“Let me give you an example of the factors that come into play when a rural hospital readmits a patient,” Hannon said.  “An elderly patient was admitted for a small bowel obstruction. Her surgery was successful and her physician recommended a skilled-nursing facility (SNF) for post-acute care. However, as is very common in small, rural areas, she is fiercely independent and refused to go to the SNF. As a result, her condition worsened, and she had to be readmitted. We persisted in working with her and she eventually did agree to skilled care, but only after two more admissions for the same diagnosis.”

So what would these bureaucrats do?  Force her to accept medical care she doesn’t want?  You might think it’s stupid to refuse, but it ought to be her choice.

It is clear that the people behind government health care have no clue how the system works in reality.  The focus on cost control will kill any individual choice in what happens to your body.  Didn’t we fight a war about that, once upon a time?

Speaking of choice, where is the uproar from pro-choice people about the restrictions socialized medicine puts on their rights in their bodies?  You’d think they’d be screaming to high heaven about it.  Don’t those rights extend beyond their ovaries?  And pro-life people have a stake in this, too.  Abortion is a lot more cost-effective than child birth, both short- and long-term.  It’s much cheaper to have fewer people in the system, after all.

Everyone has a dog in this fight.  You should start backing yours by telling Congress what you think.

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