Medicare fines over hospitals' readmitted patients to begin on Monday Oct 1,2012 - page 3

Medicare fines over hospitals' readmitted patientsding... By RICARDO ALONSO-ZALDIVAR, AP 42 minutes ago My take on this is: This could have positive implications for nurses in that if alot... Read More

  1. by   JZ_RN
    Those people are greedy. They want us to make them better with no sacrifice or effort on their part.
  2. by   Patryk
    In my opinion morte is absolutely right.
  3. by   MunoRN
    The readmission incentives started at my Hospital 3 years ago. We were one of the Hospitals that took part in the pilot program. We cut our 30-day CHF readmissions from 18 to 8%. This certainly didn't hurt Nursing, we lowered our ratios on our cardiac unit and hired additional Nurses to help track patients after discharge. We made back the money we spent and had some extra left over, and CMS ended up paying less, so it worked out pretty well for everyone involved.

    There certainly is some incentive for Hospitals to avoid readmissions, even on patients who should be readmitted, and we should keep an eye out and make sure that doesn't end up happening, but that's actually extremely unlikely. Hospital administrators don't decide to admit patients, MD's do. The incentive for MD's is to admit, whether it's appropriate or not. So while administrators might put pressure on MD's to think twice about readmitting, I've never met an MD who gives a s%&# what the administration wants, in fact they're probably more likely to do the opposite just to make a point.

    I like the general idea, although I don't agree with how CMS is implementing this particular plan. In general, complaining that too many patients are non-compliant and there's nothing we can do about that isn't a valid argument. Hospitals aren't being compared to a theoretical world where these patients don't exist, we're being judged against each other and we all have these types of patients. The problem is that while CMS does use an algorithm to even the playing field between Hospitals that have a disproportionately high number of these people and those who are lucky to have fewer of these "difficult" patients than average, I don't think it adequately captures these differences. There are areas where the views on healthcare are just much different and take a much higher proportion of Medicare dollars than other areas, partly due to ridiculously high readmission rates (Louisiana I'm looking at you). Unfortunately, a hospital in Louisiana that does an excellent job of preventing readmissions (compared to doing nothing) will still have a higher readmission rate than a Hospital in Iowa that does nothing to prevent readmissions.

    While I don't like this plan, I don't like the idea of a complete economic collapse in the US due to healthcare costs even more, so I'll take what I can get if it means Hospitals will still exist when I'm retired.
  4. by   MunoRN
    If you're curious what your hospitals readmission rate is:
  5. by   suanniam4
    Home Health RN here. Starting 2013 there will be medicare cuts to home health, possibly a copay per 9 week certification
    period. This leads to decreased visits, increased documentation, limited CNA use(medicare doesn't pay for CNAs) and increased
    accountability for rehospitalization. Hospitals are already choosing HHa that have the least rehospital rates, that may lead to them
    being picky and choosing cases that are not chronic repeaters. No job security here!!
  6. by   kcmylorn
    I think cutting the funding to home health, and therefore the usage of home health is cutting the nose off to spite the face. How are we to get continium of care if Home care benes are cut? Has any of the Home care Nurses written a letter to the CMS or DHS about this? (as stupid as it sounds).
  7. by   BlueDevil,DNP
    Here the nurse navigators are not connected to cancer treatment. Cancer patients may have them as well, but the Navis I was referring to are specifically charged with preventing readmission.
  8. by   MunoRN
    Home health has been the main beneficiary in the 4 years we've been working with this new rule. Increased use of home health accounts for the majority of the cuts we made to our readmission rates.

    Home health will be seeing a reduction in their reimbursements, which I'm fine with. Home health is not only one of the most profitable sections of healthcare, it's one of the most profitable industries in general. For comparison, look at companies that do pretty well for themselves; Nike for instance runs a profit margin of about 9%, HP and Dell run closer to 6%. Home health runs a profit margin on medicare patients of 19%, or about $3.6 Billion per year. The reimbursement cut is only 2.3 percent, which will mean they'll have to get by with $3.51 Billion in profits rather than $3.6.
  9. by   Havin' A Party!
    Quote from SC_RNDude
    ... I don't think that will have much impact on staffing...
  10. by   Havin' A Party!
    Quote from chuckster

    Sadly, this is probably true.

    ... the average fine is going to be $125,000, that is pretty close to the cost of hiring just one additional nurse. So in our example, the cost to avoid the fine is ten times greater than simply paying the fine. The rational economic decision is clear...
  11. by   Havin' A Party!
    Thanks for the site, Muno.
  12. by   hawkfdc
    I'm a home health RN for another week or so (getting the he** out of healthcare). This readmit thing is getting bad. The reality for those of you in bedside nursing and PCP offices is that I can only do so much with a stethoscope and a blood pressure cuff. Most PCPs don't go into the hospital anymore so when I call an MD with an adverse finding at a HH visit, I expect an intervention NOW, not 24 hours from now. And the intervention should not be "send them to the ER I haven't seen this patient in 4 months." For example, 2 weeks ago, visit to Mrs. "Smith", she was feeling kind of weak, took her BP, sitting 110/70, standing BP 68/46. Ok Mrs. Smith, let's call your PCP. Her doctor was a family doctor connected to a hospital system. After I spent 15 minutes on hold waiting to speak to a live person, I spent another 15 minutes telling the operator why I need the MD/NP/PA to call me back. I waiting another 30 minutes or so with the patient, no call back. So I gave her the intervention myself, have a can of chicken noodle soup (all of it), drink 2 tall glasses of water and I'll be back in an hour to check on you. And don't take anymore BP meds (physically took them out of her pill box). Went back in an hour and she had improved but I did not receive a call back from the doctor until the next day.

    I cannot stop a stage 4 lung cancer patient from developing pneumonia, nor can I head off that case of steroid psychosis r/t steroids at chemotherapy. Here's a news flash, patients are non compliant, especially in their own home. Crappy food, poor living conditions, and limited caregivers make for a difficult environment keeping these people well in the home.