...[F]inancial incentives could actually punish physicians for doing the right thing.What will happen to American medical care when doctors are punished for keeping patients alive longer (and thus surviving for followup admissions), whereas they get rewarded for having fewer readmissions?
A recent study from Cleveland Clinic shows how this could happen. The Clinic studied hospital readmission rates for patients with heart failure. It is often considered a sign of poor quality care when a heart patient, once released from a hospital, must be readmitted for further treatment. Turns out, this may not be the case at all.
Writes Karen Pallarito for the HealthDay Reporter, the Clinic reasons that “[k]eeping more patients alive for a month in the first place means there are more patients eligible for readmission... They also suspect that assuring appropriate care for these patients, including any necessary procedures or surgery, may necessitate readmission to the hospital -- which would drive up readmission rates.”
The results of the study showed that high readmission rates actually corresponded to lower 30-day death rates. The Cleveland Clinic's 30-day readmission rate for heart failure was 28 percent, 3.3 points higher than the national average. But their 30-day death rate of 8.8 percent was 2.4 points below the national average.
Starting on Oct. 1, 2012, Medicare payments for hospitals with high readmission rates for certain conditions, including heart failure, will be reduced. This means Obamacare may actually punish hospitals and physicians for providing better quality care.
Do you want to be the patient who gets denied care in order to keep a hospital's readmission statistics down?
(Via Dr. Milton Wolf.)
