Anyone who checks into a hospital is likely already looking forward to the day they check out. Ideally, the reason they entered the hospital in the first place will have been either managed or cured when they leave. But even if it seems so at the moment, many patients are readmitted within a month after discharge. In fact, for those receiving Medicare, the rate is about one of every five patients in about half of the nation’s hospitals.
The government has been tracking these figures for five years as part of the Hospital Readmissions Reduction Program which was created by the Affordable Care Act. Those hospitals that exceed the numbers that Medicare thinks is reasonable for that hospital’s patient population in comparison to the overall hospital industry are fined, this year to the tune of a combined $420 million.
The study specifically looks at patients with one of five conditions: heart failure or heart attack, chronic lung problems, pneumonia, or elective knee or hip replacements. In addition to those with high readmission rates, hospitals with other avoidable types of patient harm and those with high infection rates are also fined.
While some states have many hospitals on the list, Louisiana has one hospital located in Winnsboro that was singled out in this year’s evaluation because it has received the maximum penalty in every year since the study started. But some of the facilities that are repeatedly fined point to factors that Medicare is not taking into account when computing its numbers.
A bill has been introduced in the Senate that would require socio-economic factors to be included in the evaluations. For example, patients in some areas with lower incomes or more poverty may not be able to follow doctors’ directions when they are discharged, such as eating healthy diets. Others may not be able to afford the medications prescribed.
Whatever the reasons, medical malpractice or hospital negligence may contribute to the need for patients to be readmitted. If you or a loved one has been readmitted due to the shortcomings of care in a hospital, you may have a claim against the hospital for unnecessary pain and suffering. A consultation with an attorney who handles medical malpractice cases can help you evaluate your specific situation.
Source: Kaiser Health News, “Half of Nation’s Hospitals Fail Again To Escape Medicare’s Readmission Penalties,” Jordan Rau, Aug. 3, 2015