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Readmission Rates

Readmission rates: How the Duette™ can make a difference.

Readmission to a hospital may not mean much financially to the patient being readmitted, but to the hospital, this has become a critical factor because readmission rates are used in determining a hospital's quality of care rating. Although, sometimes a patient may have to be readmitted for a circumstance that is simply not related to the quality of care received at a hospital and was simply unavoidable, hospitals are still held accountable for all readmissions. Insurance companies and others responsible for providing payment for services have begun refusing to pay when a patient is readmitted. The Centers for Medicare and Medicaid consider an admission to the hospital to be a readmission if it happens within 30 days after a patient is discharged. To determine a hospital's readmission rate, divide the total number of patients readmitted within a seven-day time frame by the total number of discharges from the hospital.

Hospitals have struggled for years with readmission rates and finding a solution to the problem, but now the government has stepped in and is forcing change by penalizing hospitals financially when patients are readmitted. Medicare is cracking down hard on hospitals that top of the list of high readmission rates. Under the Affordable Care Act, the maximum penalty, which Medicare has already levied on many hospitals, is a 1% decrease in their payments for every patient for a year. This is an extreme financial burden for hospitals, but Medicare found it necessary in order to cut down on their expenses and encourage better care. Medicare and other insurance companies view readmissions as wasteful spending and feel that it reflects the quality of care provided by the hospital. Studies show that one out of every five Medicare patients is being readmitted to a hospital within 30 days of discharge. The government has taken action by enforcing these penalties because it simply cannot afford the $17 billion that is paid every year for readmissions

Hospitals have become so fearful of the penalties for readmissions, that they have been distracted important issues such as infection control and quality of care for patients. Some hospitals even try to send patients home within 24 hours, so that they can bill for the service and avoid having the visit counted as an admission. Hospitals have focused ways to avoid readmissions versus other more important matters. The impact of penalties is going to grow as Medicare plans to increase the maximum penalty from 1% to 2% in October 2013 and then to 3% in October 2015. At the same time the list of conditions that hospitals must meet in order to avoid penalties will also expand.

So, how do the penalties work? The penalties set forth under the Affordable Care Act (ACA) are enforced based upon three medical conditions: Acute Myocardial Infarction, Community-Acquired Pneumonia, and Heart Failure. The Centers for Medicare and Medicaid evaluate the readmission rates for every hospital based upon these three conditions, comparing the actual readmissions and the predicted readmissions To determine the penalty percentage, the Centers for Medicare and Medicaid take the total payments for readmissions based upon the three conditions listed under the ACA that occurred over a three-year time frame and divide it by the total of diagnostic related group (DRG) payments over the last three years. The penalty percentage is then multiplied by the total of DRG payments for that year. The total amount cannot be higher than 1% of the total of DRG payments in the year of 2013. The penalties imposed on hospitals are costing some hospitals millions of dollars due to resultant cuts in Medicare reimbursements. Hospitals are scrambling to find a solution to the problem of readmissions because they are in desperate need to have full reimbursement from Medicare.

Because of the many cultural, educational, and economic differences within American society, it is often difficult for a hospital to meet the goals set out for them by the new Affordable Care Act. Many hospitals in depressed or poverty areas feel the penalties are too harsh. They argue that many of their readmissions are not due to a lack of quality care by the hospital, but the fact that their patient base may not be diligent in following good post-hospital behaviors such as filling and taking prescriptions or making healthy dietary or life style choices. There may be language barriers that hinder good communication between the care givers and or patients or financial duress that prohibits appropriate follow-up behavior on the part of the patients. These hospitals feel they should be afforded more latitude when it comes to readmission penalties.

The Duette™ dual-balloon catheter is helping to improve the quality of care given to patients during a hospital stay, as well as, helping to reduce hospital-associated infections (HAIs). Because the Duette™ catheter is able to help lower the risk of HAIs, it can also help lessen the likelihood a patient will need to be readmitted. Patients can continue to use the Duette™ catheter after their hospital stay, which will also help reduce readmissions. To learn more about this extraordinary new catheter, please visit the homepage.

 

 

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