Medicare Reimbursement Changes- In-Patient Hospital
This may actually turn into several posts, because there are going to be changes (some increases, some decreases) in the amount that Medicare will be paying out to facilities and providers over the next few years.
Part of this is in response to the Patient Protection and Affordable Care Act (PPACA) (aka “Obamacare”), and its efforts to rein in federal spending. Part of it is to improve quality of patient care.
Starting in October 2012, hospitals with a higher than expected readmission rate for patients within 30 days would face a reduced rate of reimbursement; the rate is based on a formula that reduces reimbursement as the percentage of readmission increases. The diagnoses of focus are heart attack, heart failure or pneumonia. At the highest level of reimbursement reduction, a hospital would lose up to 3 percent of their regular Medicare payment.
Beginning in October 2014 (fiscal year 2015) the list of admission diagnoses will be broadened.
One potential of this change is that hospitals will be more aware of their patients after discharge, and will probably come up with a variety of ways to see that their former patients remain just that. For example, in Holy Cross Hospital, a Trinity health facility, in Silver Spring Maryland, nurses set up follow-up appointments for patients with their doctors. They also check on the patient’s transportation needs,
The article in the Kaiser Health News does not specify if this is done by the patient care nurses, or if the hospital has specific discharge planners for this (although there are discharge planners in each hospital which take care of planning transition to other facilities and arranging equipment needs, home health, etc. I don’t know which hospital staff member would be setting up the physician/transportation follow-up.)
Another possible change is the centralization of discharge planning information; as much as healthcare providers would like to think that they all are on the same page when it comes to a patient’s discharge, it is not necessarily so. Take for example the patient after a heart attack, who has new medication to take (nursing and pharmacy information), changes in exercise or activity (cardiac rehab, physical therapy, occupational therapy information) and diet (dietician information). In a best-case scenario, all disciplines have a best guess at the date of discharge; but the patient may be discharged sooner. Or have a relapse. Either throws the discharge date out the window, and possibly needing changes in the patient’s instruction.
Additional ways to minimize readmission, as discussed in this Wall Street Journal article are:disease/condition-specific instructions provided over computer or TV at bedside, “virtual discharge advocates”, “transition coaches” who call patients several days after discharge to find out if patients have their medications, have their doctor appointments and to answer any questions and patient-specific instruction booklets related to their hospitalization. Some of this has been seen before, but is updated via technology to be more specific to patients; as opposed to photocopied, general instruction sheets.
Whatever the approach, they are designed to keep the patient healthier, and less confused about their care. It should also help with sticking to changes in how they take care of themselves. And one can only help that this also leads to less intense use of healthcare facilities.
