https://consumer.healthday.com/caregiving-information-6/hospital-news-393/penalties-for-higher-hospital-readmission-rates-may-hurt-patients-740838.html
A recent study was conducted to review the outcomes from heart failure and pneumonia re-admissions after CMS imposed significant penalties for high levels of 30 day readmission.
Background: In an effort to improve efficiency and outcomes for hospital admissions with the highest frequency (heart failure – CHF, and pneumonia – PNA), CMS in 2012 imposed penalties on hospitals with the worse performance as measured by re-admission. Their thought process presumably was that higher re-admission levels indicated worse initial therapy. Moreover, repeated admissions may be an indication of “gaming the system,” admitting patients simply to collect compensation from insurance rather than because of a legitimate clinical need. Opponents of these penalties claimed that these efforts would actually be counterproductive. Many re-admissions occur in patients with multiple comorbid conditions and with the highest level of acuity. Hence hospitals taking care of the most sick and complicated patients would be unfairly penalized. Moreover, the entirety of the burden of re-admission lies at the hands of the hospitals; institutions that care for underserved individuals who rely on hospitals for their care would similarly be uniquely targeted. Lastly, hospitals that had impeccable inpatient care would be punished if the patient was non-compliant with the follow up plan, no matter how precise it had been laid out.
Most frightening was the fear that, in the face of serious financial penalties, hospitals would block re-admissions that necessitated inpatient care, attempting instead to care for them in the ED or clinical decision units. From an ethical perspective this is terrible. From a financial standpoint, however, it is brilliant. Treat the patient in the ED, hope for the best, and if they are discharged home and have a poor outcome it is not on the hospital!
Sadly, it appears that the detractors were correct with their doomsday predictions of the well-intentioned CMS initiative. The aforementioned study blames 10,000 patient deaths (!!!) on the financial penalties and the changes to hospital protocols, workflow and clinical work that occurred as a result. Over and over we have seen initiatives instituted in medicine without adequate supporting data fall flat on their face and have the opposite effect in reality. Perhaps CMS will take this study into account and consider it deeply before continuing to make unsubstantiated changes to reimbursements.