By Anne Fox
When we worked so hard against The Affordable Care Act ("Obamacare"), we opposed it for four reasons. One of those reasons was its in-built rationing.
According to a study published Tuesday in the Journal of the American Medical Association, an Obamacare provision penalized hospitals for readmitting Medicare patients within a month of being discharged and led to increased mortality rates among adults who experienced pneumonia and heart failure. The provision imposed financial penalties on hospitals with too-high readmission rates for patients with heart failure, heart attacks or pneumonia starting in 2012. It was supposed to encourage better care. But it has encouraged something else: Medicare has levied approximately $2 billion in penalties on hospitals since 2012.
To add insult to injury, many of these hospitals serve the poorest and the sickest older Americans, those less likely to have access to quality, regular care and more likely to be readmitted within a month of being discharged.
Medicare has docked these hospitals up to 3 percent of normal reimbursement if they have higher-than-expected 30-day readmission rates for six conditions: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, hip/knee replacement and coronary artery bypass graft surgery.
The Hospital Re-admissions Reduction Program (HRRP) cut readmission rates by 3 percentage points for heart failure, 3.6 percentage points for heart attacks, and 2.3 percentage points for pneumonia between 2010 and 2016.
But those decreases may have come at the cost of patients’ lives, according to the study. The HRRP’s implementation was associated with a “significant increase” in post-discharge mortality trends among Medicare beneficiaries hospitalized for heart failure and pneumonia, the study’s authors wrote.
The study looked at roughly 8 million Medicare beneficiary fee-for-service hospitalizations from 2005 to 2015. The study authors were not able to definitively link the program to increased post-discharge mortality and said the correlation “requires further research.”
The program was changed in September 2018 so that hospitals serving lower-income, older adults are not hit as hard by the penalties. The Center for Medicare & Medicaid Services is still fining hospitals for readmitting patients at too high a rate, but the penalties now are spread more evenly among safety-net hospitals that serve low-income patients and more affluent institutions.
Does that mean that fewer patients will die unnecessarily now than did between 2012 and 2018?
Obviously, it is imperative to get rid of O-care, which will, literally, save lives.