Traverse City Record-Eagle

Other Views

October 6, 2012

Another View: Leave health care to experts

A costly addition, Section 3025 of the Affordable Care Act, requires that section 1886(q) be added to the Social Security Act establishing the Hospital Readmissions Reduction Program.

This program establishes the excess readmission ratio, which is used in part to calculate payment adjustments to hospitals that fall below a bright line used by Medicare for hospital readmissions after some medical procedures.

As pointed out in an earlier editorial this month, MidMichigan Medical Center-Midland and MidMichigan Medical Center-Gratiot were above that bright line and will face no penalties this year.

We mention "this year" because the way the bright line is determined ensures that every year a certain percentage of hospitals will be penalized. According to the Centers for Medicare & Medicaid Services, a hospital's readmission rates for patients who were initially hospitalized for acute myocardial infarction, heart failure and pneumonia is compared against a national average of like illnesses. Those falling below that average can be penalized; those above not so much.

Beginning Oct. 1, more than 2,000 hospitals in the U.S. will forfeit about $280 million in Medicare funding over the next year, an amount that could double in 2013 and triple in 2014. Even if all hospitals improve their readmission rates, some hospitals will necessarily fall below the bright line, or national average, and face penalties.

According to Kaiser Health News, nearly one in five Medicare patients return to the hospital within a month of discharge, a rate the government deems "a prime symptom of an overly expensive and uncoordinated health system." ...

Kaiser Health News quoted Dr. Kenneth Sands, a senior vice president for Beth Israel Deaconess Medical Center in Boston: "A lot of places have put in a lot of work and not seen improvement. It is not completely understood what goes into an institution having a high readmission rate and what goes into improving it." Yet, CMMS is barging ahead with the penalties, which most likely will become a permanent part of the medical landscape, a tax upon hospitals which may not even know why their patients return.

Medicare will also be flexing its financial muscle in a few months when it begins penalizing or rewarding hospitals on "how well they adhere to basic standards of care and how patients rated their experiences," according to Kaiser.

This leads us to believe that the government, in this instance Medicare in particular, knows more than the experts about patient care — an arrogant attitude at best. At worst, this is another example of a health care law hastily put together with little regard for outcomes.

-- Midland Daily News

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