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Medicare fines record number of hospitals for excessive readmissions


Medicare

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(NaturalNews) Medicare is public insurance that covers some or most, but never all, medical expenses for folks 65 and over. One has to enroll with Medicare Part A, which helps cover most hospital expenses, and there is no premium involved. One has to request Medicare Part B and make small premium payments to extend that coverage to doctor's office visits and outpatient services.

Both Parts A and B have deductibles and co-payments designed to fit most older folks' limited budgets. What's paid from their coverages are generally less than what practitioners and hospitals would prefer to charge.

But the baby boomers have been blooming for several years now, and older folks have more ailments than younger people. So the medical business revenue from that sector has been high.

In other words, Medicare is a boon for the medical business no matter how many in the business complain about it. A lot of older people wouldn't have any insurance if it weren't for Medicare, then who would pay the bills, eh, doc?

Monitoring the medical business for fraud and excessive charges

Kaiser Health News (KHN) staff writer Jordan Rau wrote, "Medicare is fining a record number of hospitals -- 2,610 -- for having too many patients return within a month for additional treatments, federal records released Wednesday show. Even though the nation's readmission rate is dropping, Medicare's average fines will be higher, with 39 hospitals receiving the largest penalty allowed, including the nation's oldest hospital, Pennsylvania Hospital in Philadelphia."

So the in and out and back in routine isn't working out too well. But some have improved on that revolving patient door activity. The Medicare system tries to control their spending by curbing fraud wherever they find it. Problem is, it costs money to do that, and regardless of whatever fines are laid out, there may not be sufficient recovery.

Large fines and jail time can send shock-wave warnings for those thinking of gray areas or outright fraudulent revenue schemes by bilking the government. But Medicare has another method for punishing hospitals with rapid reentries.

They have the Hospital Readmissions Reduction Program (HRRP) for enforcement. There are around 1,400 medical services that are exempt from HRRP standards, including psychiatric wards, emergency services and cancer clinics.

Instead of an outright fine or criminal charges on individuals who may be involved, Medicare has listed all the hospitals that accept Medicare coverage, which are almost all US hospitals, and tracked the release and admission dates of people under Medicare. Attention has been on patients being readmitted for the same or similar issues within a month of release.

Instead of outright fines or criminal prosecution if appropriate, the punishment is rendered by lowering that hospital or clinic's Medicare payments for services rendered during the following year, not just for readmitted patients, but for all Medicare-covered patients.

The reduced-payment percentages range from a tad above zero to 3 percent, which is 1 percent more than the last round of penalties that was capped at 2 percent. Among the 2,610 hospitals harnessed with Medicare payment reductions, 433 more hospitals than last year, 39 hospitals have been hit with the federally allowed maximum of 3 percent.

The complete list of hospitals and locations with their percentages of payment reductions can be viewed here [PDF].

Before the HRRP was instituted, hospitals were skimpy on following up with released patients, including providing their drugs or having practitioners or caretakers visit their homes, because they weren't paid for those services.

Getting new patients in was a priority, so patients were released with an instruction sheet, and if one of those released didn't follow his or her instructional release guide properly, the hospital would soon be readmitting that patient.

Medicare's HRRP has somewhat influenced better follow-up care with hospitals while saving billions of dollars annually.

Sources:

http://www.medicare.gov

http://www.kaiserhealthnews.org

http://wuwm.com

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