By in Health & Fitness

Is Medicare Hospital Payment Policy Self-Defeating?

Medicare has a number of safeguards built into its payment system that are intended to ensure the highest quality care for patients at predetermined costs/prices. One of these safeguards in particular may be well-intended, but an untoward outcome could result in there being fewer hospitals who will agree to provide care to the poor.

One of the criteria the Centers for Medicare & Medicaid Services , CMS, uses to determine payments to hospitals is the percentage of patients who require readmission to that hospital within 30 days of discharge.

On one hand, this criteria makes sense because that 30-day window for readmission of a person to the hospital within 30 days of discharge from a hospital has been established by the medical community as a measurement of the standard of care of the discharging hospital. A person who has been hospitalized should be able to expect that his/her condition has been stabilized sufficiently for safe discharge and any after-care services have been arranged by the hospital prior to discharge.

Taken in and of itself, this standard of care seems reasonable -- all things being equal. However, in the real world, not all hospital patients nor their after care are the same.

At writer Peter Ubel points out that studies have shown that unmarried and poor people disproportionately return to the hospital for readmission in less than 30 days. Hospitals who treat a high number of people in these categories are more likely to then earn less in Medicare reimbursement.

Unless the standards of this intended safeguard are restructured to more accurately deal with these realities, the may be fewer hospitals in the future willing to accept the unmarried and poor, and/or Medicare recipients due to a continuing loss of revenue.

Resources:; " How Medicare is Punishing Hospitals That Care for Poor People "

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Kasman wrote on October 30, 2014, 6:45 PM

Living in the UK with its National Health Service this is not a problem we face. In the UK all health treatment is free at the point of delivery. It is paid for by general taxation.

maxeen wrote on October 30, 2014, 7:24 PM

This sounds like an absolute nightmare to me. I live in the UK and we have the NHS which is a wonderful thing. Sorry for youe dilemmas !

Crin wrote on October 30, 2014, 7:39 PM

Feisty56 , I suppose we have to cross this bridge one day. Hospitals though can't turn back a patient more than the insurance companies can turn down a prospect for preexisting conditions. I think that in the future we are going to address the concept of for profit health care.

Ellis wrote on October 30, 2014, 7:56 PM

For profit anything will always see some people get shafted...

BarbRad wrote on October 30, 2014, 11:12 PM

American health care is currently in a mess. Many of the people who did not have health insurance before Obamacare was enacted didn't want it because they were young and healthy. People were promised their health insurance would be cheaper when the law took effect and they are discovering it isn't. We were promised that if we liked our doctors or plans we could keep them, and for many people that's also a broken promise. Health insurance is more expensive than ever, many doctors are leaving the profession, and we still have more uninsured people than we had before. Insurance companies are coming between patients and their doctors. It would have been so much simpler to simply subsidize those who did not have insurance and leave everyone else alone than to form this huge and inefficient bureaucracy that inserts another level of bureaucrats between people and their doctors.

BarbRad wrote on October 30, 2014, 11:14 PM

The UK is not as big as the USA, and does not require so many bureaucrats to manage the system.

alexdg1 wrote on October 31, 2014, 12:16 AM

There's a witty (and accurate) observation made by Dr. Leonard McCoy in 1986's "Star Trek IV: The Voyage Home" that fits this topic:

"The bureaucratic mentality is the only constant in the Universe."

And, as I recall, Dr. McCoy didn't think highly of (then) contemporary 20th Century medicine.......

Ruby3881 wrote on October 31, 2014, 4:11 AM

Just when I think I've heard the worst about American medical care, I learn about some new detail that causes me to shake my head - vigorously! How sad that those who most need the help may be least likely to get it!

SLGarcia wrote on October 31, 2014, 1:11 PM

From my point of view it is the insurance companies that have continued to raise their rates every year for the last approximately 15 to 25 years by about 30 to 40 percent. As far as I am concerned it is the insurance companies that are causing higher rates, not the government. The insurance companies want to keep their profit margins as high as possible. I have found that many more people now have health insurance who could not afford it previously. No system is going to be perfect, just as the health program in the U.K. is not perfect for everyone based on what I have been told by friends their.

AliCanary wrote on November 1, 2014, 2:51 PM

I guess that unmarried and poor people are less likely to receive the ongoing care at home that would help in their recovery. I have no suggestions as to how this problem could be alleviated, though. :/