The Affordable Care Act is hitting implementation markers that stretch out years into the future, and health care is changing, almost imperceptibly sometimes.
But you pay attention when the changes hit home — take, for instance, young adults who can now take a ride on their parents’ health insurance coverage until age 26. Or people who received checks from insurance companies this year because health insurers must refund a portion of premiums paid if they do not spend at least 80 percent of premium revenues on patient care.
Another aspect of reform kicked in this week: penalties for hospitals with high readmission rates. Government estimates are that roughly 2 million Medicare patients are readmitted for complications every year, adding an estimated $17.5 billion to the cost of the health program for seniors.
Based on hospital records for readmissions for heart failure, heart attack and pneumonia, the feds began Monday to apply the penalties. Hospitals will lose a percentage of their Medicare reimbursement (a maximum of 1 percent this year) if too many of their Medicare patients are readmitted within 30 days of discharge. The penalty for high readmission rates will rise to 3 percent of reimbursement over the next two years.
Is this another quality-of-care measure that hospitals can use for bragging? Perhaps. With the increased focus on financial efficiency, a reputation for revolving-door admissions and repeated losses in federal funds certainly wouldn’t be good for business or good PR, either.
But the fascinating thing about the evolving health-care reform is that while the big changes (such as health insurance exchanges or individual mandates) catch the imagination, I think it is the ripple effects from tightly targeted provisions such as readmission rates that offer consumers a clearer sense of how the care they receive is likely to change.
Say a local hospital is eager to reduce the number of elderly patients making return trips to hospital wards. With money and reputation on the line, the odds are good administrators, if they haven’t already, will examine their entire system, find out why their patients are coming back and focus, laserlike, on changing the factors within their control.
That urgency for re-examination is precisely what the law is supposed to inject into the reform process. Medicare is a huge program, and if hospital administrators and physicians identify what works best in care delivery to keep re-admissions and extra costs down, you can bet those features will be applied to care for the general patient population.
Analyses of the Medicare penalty this year indicate that for most hospitals, the loss would be a tiny fraction of their annual revenue. Thus the more important consideration is whether the stick proves effective in spurring corrective procedures that can transfer to the care delivery for the general population.
Researchers have identified some common reasons for readmissions. One strikes an instant chord: Patient confusion about what to do once out of the hospital. Many patients do not fully comprehend follow-up instructions and there often is little or no co-ordination between the medical personnel and caregivers when patients leave the hospital to go home or to a nursing facility.
I had an “invasive” procedure more than a decade ago. The surgery went well; there were no complications; and I was discharged home with a pep talk from the surgeon and instruction sheets for prescriptions, what to do and what not to do. The day after discharge, on a weekend, the phone rang. “Your surgeon on the line,” said my husband.
He was checking on me to be sure I had no problems, that I had the right medications, that I understood what to expect in the next stage of recovery. … I was mighty grateful. I assumed the call was standard procedure. I found out otherwise. Point is, if there had been an issue, he would have caught it before it became a crisis leading to readmission. Policy analysts point out that changing some of the factors within the control of providers need not be complicated or very expensive. A little chat can make a whole lot of difference.
Ofobike is the Beacon Journal chief editorial writer. She can be reached at 330-996-3513 or by email at firstname.lastname@example.org.