Medicare change tries to limit hospital visits

(CBS News) A little known piece of the Affordable Care Act went into effect Monday. It is designed to lower the cost of Medicare to taxpayers.

Hospitals will now face big fines if too many of their patients have to be readmitted because of complications. One of every five Medicare patients ends up back in the hospital within 30 days of being released.

Roughly two-thirds of those receiving Medicare will forfeit money, up to one percent of a hospital's Medicare reimbursements.

Phil Eklof, 84, suffers from congestive heart failure and diabetes, and wound up in the hospital twice this year. He left with a laundry list of follow-up instructions and medications.

Eklof is fortunate. He has a home health care worker to help him.

"If you don't take a service like this you'll end up back in the hospital," Eklof said.

• Issue brief: Health care
• Analysts: 6M to be penalized under new health law

Federal officials are concerned that many Medicare patients nationwide fail to get the necessary follow-up care and many end up being re-admitted to the hospital, often in the same month.

The government is now penalizing hospitals for excessive readmissions in three areas: Patients recovering from heart failure, heart attacks or pneumonia. If a released patient comes back within 30 days, there's a one-percent penalty.

For example, if a hospital submits a $100,000 bill to Medicare, the penalty would reduce the reimbursement to $99,000.

In all, the penalized hospitals will forfeit about $290 million in Medicare funds over the next year.

Stephen Love, who heads the Dallas-Fort Worth Hospital Council, says the penalties are unfair to hospitals that serve primarily low-income populations.

"Hospitals that treat people in low-income areas in many cases don't have the primary care providers they need in their communities. They may not have pharmacies they need. So to coordinate that care outside the hospital is going to be very difficult," said Love, adding that much of the responsibility relies on patients themselves.

Not all hospitals are failing to meet these guidelines. Some hospital executive told CBS News the initiative is not all bad. In fact, some of those hospitals are developing their own programs to keep people healthier once they do get home and out of the hospital.

[bois-darc]

"Medicare change tries to limit hospital visits" is totally misleading; there is no limit imposed on any person going to a hospital.

It merely tries to motivate medical service providers to give a level of care needed to limit the necessity of patients having to return to get the previous encounter fixed.......

[judymar14]

Doctors have the right to refuse medicaid patients, now will hospitals have the right to refuse treatment for some ailments to medicare patients? I have a 140 page booklet from my Medicare drug program to read and 140 page booklet from Medicare changes for 2013 to read. I won't understand half of what they say. I knew the Medicare booklet will be to explain higher monthly rates and less benefits, so I really don't have to read that. Medicare could save a lot of money if they stop sending these booklets out, just a letter saying what will change in benefits for the next year would do.

[kbernally]

Glad to see there is an accountability process for inpatient admissions/readmissions. Instead of politicizing everything, people need to realize that hospitals are more accountable to insurance payments than to their patients. It's a business!! When you go to visit your doctor or go to an emergency room or a hospital understand YOU HAVE ENTERED A BUSINESS OFFICE!!! They are in it to make money even the "non-profits" are a BUSINESS!!!!!! Hospitals that accept Medicare and Medicaid will get paid..its the private insurance and private "self pays" that drive the cost up with the continual payment games that are paid. Such a complicated issue... It's time to change it and make insurance companies accountable. If you only knew...you would not be so quick to judge the Affordable Healthcare Act and it's intent to control costs.

[forumcomments]

You can't take 700 plus billion from Medicare and not reduce the level and quality of care. There are other reductions that have received less press and many start this year. Even the advantage plans for 2013 are seeing increased recipient cost which will reduce care.

[Paul_I]

Private insurance plans have created a culture in hospitals to get patients out the door as quickly as possible to manage the cost of claims. For the elderly in particular, the rush to the door often leaves them confused about treatments and sometimes leaves them still in need of care. The end result is the patient returns within a month. The admission/discharge/readmission process is itself costly. If the penalty creates a financial disincentive to balance the financial incentive to empty beds, the result will be a balance between patient care and business. We will all see how it works out. Based on personal experience with three parents/in-laws going through the medical system, this has to be a better approach than the status quo.

[Solarrays247]

Great post. I agree.

[bois-darc]

I agree with Paul!

This is a motivational approach to "do it right the first time" so the patient will not have to return...... This DIRTFT approach has been in use by industry for years, why not medical care as well!

[johnlockesghost]

"Not all hospitals are failing to meet these guidelines. Some hospital executive told CBS News the initiative is not all bad. In fact, some of those hospitals are developing their own programs to keep people healthier once they do get home and out of the hospital"---My experience with hospitalization was 1) care in the hospital, 2) care within a rehabilitation facility and 3) home care (although the latter was brief and unnecessary). So, follow this 3 step process and prevent a return to the hospital.

[John782011]

Cubscout, Very accurate. A number of associates have had problems with their knee replacement surgeries. Currently if the alignment is wrong, the surgeon gets paid again to fix it. He/she should be accountable at some level to get it right the first time. That being said, the patients also have the responsibility to continue their meds when they leave the hospital and attend their PT so they minimize infections and pneumonia.

[michaelz06]

Yep, have to pass that thing to know what's in it....

[jschm2681]

Some people just won't listen. Obama is cuting 716 billion from medicare. THis will result in less care, longer waits and maybe even no service. The 15 yet to be appointed bureaucrats will independently decide who gets what care. They don't have to be doctors. THey can be Obama flunkys who wish to save Medicare by limiting old people's treatment. There are no limits to what they can refuse to do and no one has an recourse. So Obama's move a national healthcare system eventually will destroy the good medical system we have now. You only have to look at the UK to see how bad medical care can become.
Romney/Ryan doesn't cut any coverage for anyone 55 and older. But it is tough to convince people of this.

[retmw1]

jschm

What do you care you and your party want seniors thrown out in the street anyhow. As for the 55 and over if you believe that I have a bridge I'll sell you, that's just a ploy to get votes.

[forrestt56]

To jschm2681,
The 716 million story is nothing but a lie and most Americans already know it. The Affordable Care Act helps seniors and removes some of the ways that insurance companies can deny heath care.

Mr, we DO NOT have a good system now.
You, Mr jschm2681 must own an insurance company or their stock to make such a statement. Heatlh care costs are stripping Americans of their hard earned money making them less healthy and making life in general much more difficult.

IT IS TIME TO HAVE UNIVERSAL HAELTH CARE FOR ALL AMERICANS PAID FOR BY AMERICAN TAX DOLLARS AND ELIMINATE THE HEALTH INSURANCE MAFIA FROM THE SYSTEM COMPLETELY.

Romney and Ryan??? What a joke, surely.

[facelessdrone2005]

Yeah, jschm2681, quoting the article, this will reduce the hospital bill from $100,000 to only $99,000. Bet they're really sweating bullets about losing that $1000. It's bound to take them an extra, oh, 10 seconds or so, to bill that much to make up for their loss. Yep, Obamacare is clearly reducing care to seniors, I can sure see that now. LOL

[forrestt56]

We as patients expect the doctors and nurses at hospitals to give accurate diagnosis and treatment including followup treatment when needed. They should not require the incentive of loosing some of their benefits to supply good quality healthcare. I do not think that $99,000.00 out of $100,000 is enough to hurt the hospitals but may give them pause to think...

That said, it seems that the real intent of this politically timed report is to show the Affordable Health Care Act in a less than good way.

The truth is the Affordable Health Care Act offers is a real step forward and is far and away better than anything the GOP has to offer.

Still, what Americans want and deserve is Universal Health Care for all which will get the crooked health insurance denying companies off of our backs permenantly.

One way to speed this up is to vote the GOP obstructionists out of office.
AMERICANS VOTE THE DEMOCRATIC TICKET IN NOVEMBER.

[askagain]

When my father has a stroke and was admitted to a nursing home, Medicare would only pay for three therapy sessions. We were told the family could pay for additional therapy sessions if we wanted to. And you want universal health care controlled by the government. Good luck. When our health care system is run like the postal system, you'll change your tune.

[forrestt56]

The postal system? So what?
The so-called health care system is currently run by the crooked insurance companies who take away a big portion of my paycheck and then deny me health care unless I pay deductables and co-payments too.
HEALTH INSURANCE IS THE BIGGEST SCAM IN AMERICA.
Heck yea, bring on the postal system, I'll take it.

UNIVERSAL HEALTH CARE FOR ALL!

[oldeschoolwoman]

CBS misled readers with that exammple. Medicare pays hospitals using diagnostic related groups--it does not matter how much he hospital bills they only receive the amount of $$$ assigned to the diagnostic group. So payment would be 10% less than the allowed reimbursement for the diagnostic related group (DRG) that the diagnosis and care is assigned to. This payment scheme has been in effect since the mid 1980s.

[cubscout09]

This headline is misleading and inflammatory.

Outcome based medical billing is part of the solution to egregiously soaring medical costs.

If a mechanic screws up and doesn't properly fix my car, and it is their fault, they don't charge me to correct the problem. I've experienced an incorrectly installed timing chain, a missing engine compartment panel, incompatible replacement brakes, head gaskets that didn't seal, on and on. In the last 15 months, two immediate members of my family have been sent to the emergency room because the medical professional made a mistake. Why should the medical profession be any different?

[skeezix06]

"Why should the medical profession be any different?"

Maybe because your auto mechanic doesn't have to send your car home before he's fixed it? And maybe because the doctor can't go to the people parts store and order new parts off the shelf?