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Hospital Readmission

By February 13, 2019 Personal Injury

Ten years ago, when patients receiving Medicare benefits were discharged from the hospital, one in five of them returned within one month. In response, the Affordable Care Act shepherded in the Hospital Readmissions Reduction Program. The program focused on heart attacks, heart failure, and pneumonia—three ailments with high readmission rates.

The program penalized hospitals when readmissions within thirty days exceeded national averages by withholding up to three percent of Medicare payments. After it took effect in 2012, the program appeared to work as intended, and prestigious medical journals noted significant drops in the number of readmissions, with the greatest declines showing up in the hospitals that had been doing the worst.

However, JAMA (Journal of the American Medical Association) recently published a study that reported that deaths from pneumonia and heart failure within thirty days of discharge have increased since the program began.

Although other studies are merely observational, i.e., they can track statistics but cannot explain why things happen the way they happen, this data suggests that hospital administrations may be refusing to treat patients because they are sick and have already come to the hospital for treatment. If that is the case, hospitals are deliberately refusing to readmit patients simply to avoid a Medicare penalty.