Whether it’s referred to as its official name, the Affordable Care Act, or the more commonly voiced and a tad unflattering Obamacare, the complicated legislation is changing the landscape of health care in America.
Part of that involves a welcome change in the approach to hospital readmissions.
As Henry L. Davis reported in The News, institutions that fail to adjust to the changing landscape are being penalized. Twelve facilities in Western New York were at the end of this punitive stick.
In October, Medicare began fining facilities for having too many patients returning to the hospital within 30 days of discharge because of complications.
Medicare also began rewarding or penalizing hospitals based on their performance on basic quality measures and surveys of patient satisfaction.
Hospitals, health insurance companies and Buffalo-area community organizations had already taken action to reduce readmissions, although, as Davis reported, with varying degrees of success.
But the current move at the federal level away from paying per procedure toward paying for the quality of outcomes is refreshing, and necessary.
The pressure in recent years to cut costs wherever possible gave hospitals an incentive to discharge patients quickly, sometimes too quickly. If a patient released too early developed complications and had to be readmitted, the hospital was not only not penalized, it was rewarded with a new round of reimbursements for the new procedures.
About 20 percent of hospitalized Medicare patients – 2.3 million people – were readmitted to a hospital within 30 days of discharge, according to the New England Journal of Medicine. About 90 percent of the readmissions were unplanned and cost the government $17.4 billion in 2004 alone, the study found.
Medicare now provides an incentive for hospitals to get patient care right the first time.
Bruce Boissonnault, co-chairman of the National Quality Forum Steering Committee that looked at the best way to measure readmissions, makes a good point that the penalty is an effort to encourage hospitals to coordinate care with doctors in the community.
Boissonnault is president of the Niagara Health Quality Coalition, which four years ago began an annual report card on the rate of potentially preventable readmissions for every hospital in the state.
The Affordable Care Act is not the cure-all some have touted it to be. However, in this case it manages to both improve patient care and save money.
This part of health care reform provides a clearly visible sign that the system is putting the focus where it belongs – on patients rather than cash flow. That focus is concerned with delivering care seamlessly, whether from physicians, hospitals or followup home care.
Reducing hospital readmissions is important not just for the patients, but also for taxpayers and the hospitals themselves.