Posts Tagged hospitals

Hospital Re-admission — do phone calls help?

Jphoneust calling a patient on the phone does not prevent patients from being re-admitted!

Hospitals are very interested in preventing a patient from returning to the hospital (called a re-admission) within 30 days from discharge due to the financial penalties from Medicare.

For example, if a patient is hospitalized with a serious problem called congestive heart failure (fluid retention that causes shortness of breath) the hospital will be penalized financially if the patient gets the condition all over again and has to return.

The government idea is to force hospitals to be more accountable — it’s like a 30 day guarantee from an auto repair shop!  So hospitals are looking for ways to improve their performance (and avoid paying money).

There is no question frequent visits to a physician can reduce re-hospitalizations.  However, a recent hospital study found that hospital nurses who talked to patients before discharge and who called them after discharge did not help the readmission problem — in fact there were more re-admissions!

a)  How can this be?

b) Do well meaning nurses actually make the problem worse?

c) Does this mean hospitals should not be penalized?

The answers are: a) bad science b) yes  and c) no, perhaps they should be penalized more!

The “bad science” part is because there was no intervention to adjust medications or treatments that might prevent readmission.   A hospital nurse only has one option for a telephone  intervention:  “you better get checked at the ER”.  The conclusion from the study should have been stated “chatting with a patient does not prevent re-admission” — brilliant deduction.

The outpatient care provider’s  office is where action can be taken to stop re-admissions.  That’s where medications can be prescribed.  If the hospital wanted to prevent re-admissions they should have made an appointment and given the patient a coupon for a taxi ride to and from the outpatient office.   This is not rocket science.

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Cost Shifting – the underground payment system

COST SHIFTING DIAGRAM

Hosptials are licensed by the state and certified to provide Medicare and Medicaid services.   They agree to provide care sufficient to stabilize a patient.  If the hospital is a non-profit institution they must provide community service (indigent care) in an amount equivalent to what they might otherwise have to pay in taxes.  For- profit hospitals will try to transfer indigent patients to community or state hospitals but room is limited so they often provide uncompensated care.  County, State and Federal (VA and Indian service) hospitals are financed from taxes.   Much indigent care is paid for by the government.

Uncompensated care in hospitals is funded in a circuitous (underground) manner.   Uncompensated care just means the patient can not pay — the patient may end up going bankrupt.  However, the hospitals have another way.  There is a constant stream of money that comes from insured persons flowing to insurance companies and then to hospitals.  To balance the books for uncompensated care hospitals raise the price of care to insurance companies that in turn raise the price to insured people.  Hospitals often have to negotiate the pay increases with many insurance companies.  The “system” comes into a balance as long as the numbers of uninsured patients are not too great.

The net effect of the underground system is uninsured  patients do get care and hospitals stay solvent.   However, look at the system from a distance and try to follow the money.   Complex negotiations, patient transfers, government payments, and patients shifting into Medicaid (Title 19).  The cost of doing the paperwork is astounding and combined with the cost of a social-work army it almost matches the cost of delivered care.  In the end, insured people pay twice, once in the cost of insurance premiums and second in taxes.

This is our system.  We designed it this way.  Is this graft and corruption?  No.  However, it is wasteful,  inefficient, unmanageable and unsustainable.   The most simple solution is to provide insurance for those who can not afford it.  The cost is the same and possibly less than the sum total of private and governmental costs now.  Such a system would be understandable and subject to being managed.

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