On Monday I published the post "Obamacare May Benefit COPD Patients." This was my response to an initiative in Obamacare that allows CMS to punish hospitals that have too many COPD readmissions. It explains the benefits of this initiative on the patients.
I want my readers to know that this post was in no way an endorsement of Obamacare. It was mainly an objective post to to show that this "initiative" is noble, and will benefit COPD patients. The post was addressed to COPD patients on a COPD website, and therefore I felt it was not appropriate to address the advantages and disadvantages of this initiative on hospitals.
The truth is, that while the initiative was added into Obamacare because statistics showed that COPD readmissions are both unnecessary and costly, there was no market drive for hospitals to address this issue. Now that hospitals are being forced to address it or risk a reduction in reimbursement, hospital administrations are scampering to solve this problem.
The problem here is that, while statistics show programs like this that already exist have been effective in reducing COPD readmissions, it might be impossible to meet this criteria. I will provide here a variety of reasons:
1. Most COPD patients that fit this category are at or near the end stages of their disease, are frail, and have co-morbidities, any one of which may result in a readmission. It is therefore impossible to prevent all, or even most, of them from being readmitted for one reason or another. In fact, as Stephen F. Jencks said in the April issue of AARC Times, "Two thirds of Medicare fee-for-service medical discharges are readmitted or dead within a year." In other words, they are very sick, and it may be impossible to keep them out of a hospital regardless of the efforts and good intentions of healthcare providers.
2. Staffing at hospitals will always be an issue, and this is because, while hospitals do view trends, it is impossible to accurately know when the census will be high or low. For this reason, there will be times when a hospital simply doesn't have the staff to meet all the demands of the patient population.
3. Along the same lines, respiratory therapists will be asked to take on more responsibilities when many are already dealing with high workloads and high levels of burnout and apathy.
4. There is no reimbursement for the added procedures that will be necessary to fully commit to this initiative, and therefore hospitals will hit hard with the cost of applying, and the possible cost of a reimbursement penalty.
5. Educating COPD patients is always a challenge. Jencks explains that these patients have anxiety, are on medications that may impair their judgement, are often disorientated, and are simply sick. They also may be confused or depressed, and this only exacerbates the problem. Sometimes these patients say they understand what you are explaining, but they don't.
Bottom line: Consider once more the following quote: "Two thirds of Medicare fee-for-service medical discharges are readmitted or dead within a year." The reason this statistic is true is not because they don't receive good care, it's because they are really sick people.
It only makes sense that efforts made on behalf of the healthcare profession will reduce COPD readmissions. The questions that remains is: will these efforts be good enough to meet criteria set by the government? It is my humble opinion that this system is set up to fail.
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