Costly Penalties for Repeat (Hospital Patient) Offenders

Spending time in the hospital can be traumatic, or just an inconvenience—a chunk of time spent outside your regular life in order to deal with a health situation, get treatment for a chronic illness or just to have a baby. Not many hospital patients, once released, would look forward to the day they can go back. It’s just not the kind of place, no matter how caring and comfortable hospitals try to make it, that you would choose to spend your time.

Returning to the hospital is expensive, for patients and hospitals alike. In fact, according to the new provisions of Obamacare, too many readmissions will make it very expensive for hospitals in the way of hefty fines. These provisions, according to a New York Times article, “Hospitals Question Medicare Rules for Readmissions,” are costing hospitals that are spending millions of dollars following up on patients once they leave the hospital to ensure they stay well.

The good news, according to federal statistics, is that readmissions are going down. But critics question whether it’s the hospital’s responsibility to act as a watchdog for patients once they leave the hospital. Whose responsibility is it if Aunt Beverly takes her medications or Uncle Roger goes to his follow-up doctor visits? Hospitals are going as far as making appointments, setting up transportation and making phone calls to encourage patients to continue their care after release from the hospital.

Treating patients for critical illnesses at a hospital isn’t the same as taking a car in for a 100,000 mile check-up or extensive repairs after a collision. While you may have to take the car back for some minor adjustments after it’s returned, treating illnesses can require readmission for as many reasons as there are types of patients and conditions. Obamacare takes the position that readmissions are the result of poor follow-up care and are demanding hospitals take on the responsibility for not only curing a patient but for keeping him well. 

Anyone who has been in hospital for an illness or procedure knows the double-edged sword of being released. You’re happy to be out of the hospital environment and back home to familiar surroundings. But you’re also anxious about leaving the same environment that monitored every aspect of your care—therapy, medications and those pesky checks on your vital signs round the clock. It’s comforting to have an expert caregiver watching over you. Faced with pages of home-care instructions and bottles of medications, it can be confusing and a little scary facing life after release. Hospitals are now being forced to take on the role of home-health provider as well.

Some healthcare providers see this as an opportunity to greatly reduce the cost of healthcare. In fact, the article states that nearly two-thirds of hospitals that receive Medicare payments are expected to pay big for unusually high readmission rates for Medicare patients. Hospitals make money treating patients. And hospital care is expensive. No one denies that. But taking more care of patients while they are in the hospital and monitoring them after release may prevent a costly second or third hospital stay.

Hospitals will have to weigh the cost of this after-care to the cost of the penalties. Some hospitals may have high readmission rates because they treat more critically ill patients or those from lower socio-economic areas. There is controversy over which measures are most effective in preventing readmissions or ensuring patients take care of themselves once released. 

There are so many variables that it’s almost impossible to impose one set of guidelines. Hospital care is, after all, not a “one-size-fits all” type of business. What works for a hospital in sunny Arizona or Florida may not work for one in Detroit’s inner-city. But whatever cuts down on the trauma of readmission and the costs that go with it may be a welcome change for both healthcare providers and patients alike.

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