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Wednesday, December 11, 2013

COPD readmission penalties may doom hospitals

In order to save money, the Centers for Medicare and Medicaid Services (CMS) has decided to penalize hospitals for high readmission rates.  This includes diseases such as heart failure, pneumonia, and COPD.  It's no coincidence these are some of the most reimbursable ailments.

While this looks on the surface as an attempt to help these patients stay healthy, the true reason, as noted above, is twofold:
  1. To give the government a reason not to pay
  2. To force the healthcare system to collapse.
The reason I say this is because it's impossible to comply with this measure.  Most patients with COPD are at high risk for getting pneumonia because of all the phlegm that gets trapped in their lungs.  They are at high risk for getting heart failure because of the extra work the heart has to do to pump blood through diseased lungs.  

Plus COPD patients are at high risk for a variety of other ailments, such as diabetes due to chronic steroid use, skin ailments due to steroid use, stomach trouble due to steroid use, and heart ailments such as atrial fibrillation.  So there is a long list of reasons such a patient may be admitted, or readmitted  

I applaud the idea of providing incentives and encouraging hospital administrators to find better methods of educating patients.  However, I think it's a bad idea to simply say you're going to penalize hospitals even more by a system that has already diminished reimbursement to hospitals.

Such a measure cannot possibly succeed.  That's my opinion.  What's yours?

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Anonymous said...

Rick, you're still using the old way of thinking. In the past all we did was treat the patient for their acute problems when they walked through the door. Now we must shift our thinking to figuring out why the patient is acutely ill in the first place so that we can prevent that from happening again, or quite so often... what kind of exposure have they had? How well are they taking care of themselves? Are they using their medications properly? Do they need to be in a nursing home?

Data are already coming in that are showing a reduction in readmission rates.

Rick Frea said...

I'm not saying I disagree with you, but the general consensus where I work (and I communicate regularly with the admins) is our small town hospital cannot support such a one size fits all program.

Anonymous said...

Technically speaking, this new policy is forcing hospitalists to do what family physicians should be doing.