The natural progress of things is for liberty to yield and government to gain ground. —THOMAS JEFFERSON, 1788

Obamacare’s penalties on hospital readmissions will kill off the sick and elderly

Expect hospice care to flourish (Credit: Wikiedia Commons)

Expect hospice care to flourish (Credit: Wikiedia Commons)

If you have an aging parent or other elderly relative who is currently hospitalized with chronic heart or lung disease, the good news is he is coming home. The bad news is that he is likely coming home to die. That’s thanks to a strong disincentive for hospitals to readmit chronically ill Medicare patients under a provision of Obamacare.

Called the Hospital Readmissions Reduction Program (Section 3025 of the Affordable Care Act added section 1886(q)), the provision took effect on October 1, 2012 and penalizes hospitals for readmitting patients with one of several high-maintenance conditions — heart failure, heart attack and pneumonia — within 30 days of discharge. Two additional expensive-to-manage illnesses, Chronic Obstructive Pulmonary Disease (COPD) and follow-up treatment for coronary bypass surgery, are scheduled to be phased in this year.

In the view of the Medicare Payment Advisory Commission (MPAC), readmission of Medicare patients with any of these illnesses is an admission — of failure on the part of doctors. The government believes that if the correct treatment were administered during an initial hospital stay, these patients wouldn’t need to return. As a corrective measure, the law imposes a hefty fine on hospitals that readmit chronically ill patients. MPAC estimates that the fines collected will ultimately restore $1 billion to Medicare’s depleted coffers.

Currently, one in five elderly patients is readmitted within the 30-day window. Many of the readmissions result from unanticipated changes in the patient’s condition or a planned follow-up treatment. But roughly 12% are caused by patient confusion over new drug regimens, inadequate follow-up with primary care physicians, or a family’s inability to deal with home care. These “avoidable readmissions,” the government insists, are the fault of hospital staffs for not doing a better job of educating patients and/or administering better preventive care.

There are two problems with the approach. One, spelled out in an article at the British medical journal The Lancet, is that some of these chronic diseases in the elderly are tricky to manage. “Frequent readmissions,” the authors note, “might simply reflect the nature of the patient population rather than poor health care.” They add:

A 30-day readmission rate might be a suitable measure of health-care delivery for some conditions or surgical procedures, but for patients with COPD a more sophisticated gauge of success that incorporates medical, social, functional, and economic elements is needed.

The other problem is how hospitals and doctors on staff respond to the penalty. The most likely scenario is that they will now become de facto agents for the law’s death panels, urging Medicare patients at their time of discharge to sign do-not-resuscitate orders and seek “comfort care” instead of future medical treatment.

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Howard Portnoy has written for HotAir, NewsBusters, Weasel Zippers, Conservative Firing Line, RedCounty, and New York’s Daily News. He has one published novel, Hot Rain, (G. P. Putnam’s Sons), and has been a guest on Radio Vice Online with Jim Vicevich, The Alana Burke Show, Smart Life with Dr. Gina, and The George Espenlaub Show.

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  • J.e. Dyer

    “The other problem is how hospitals and doctors on staff respond to the penalty. The most likely scenario is that they will now become de facto agents for the law’s death panels, urging Medicare patients at their time of discharge to sign do-not-resuscitate orders and seek “comfort care” instead of future medical treatment.”

    Exactly: the perfect progressive solution. Place regulatory pressure on supposedly private, independent actors, so you can have your death panels and deny them too.

    • pandainc

      Tch, tch, lady O. Such a cynic you is.

      • rs1123

        She’s a realist. You are a denier with your head in the sand.

      • J.e. Dyer

        LOL – pandainc is good troop, rs1123. This was a leg-pull.

      • pandainc

        Thanx, J.e. I guess I’m going to have to type (sarc) so some folks can understand it. On the other hand, NOT.

      • J.e. Dyer

        :-) I suspect rs1123 will get onboard smartly. (Which is a backwards way of welcoming rs aboard.)

    • Steven

      J.e.D….It was some sort of bizarre atmospheric refraction, but passing the Phoenix VA last week, on the way to a Grieg piano concerto, I looked past the mountains and clearly saw Russia.

      Steven

  • teejk

    Sarah Palin having a little “told you so” moment…like Romney on the Russian threat…I’m sure the network news will be offering their retractions soon (anybody ever wonder where my avatar came from?).

    • Steven

      Pigs fly? They began flight the day Obama was elected.

      Steven

  • rambler

    All by design. Kill off the elderly and they won’t need those social security checks or medicare.

    • xoxozo

      The Progressives have believed in it for 80+ years. G oo gle “george bernard shaw eugenics video” to see how it works

      • rambler

        It wasn’t just dear Georgie who supported eugenics and the fabian society beliefs. Margaret Sanger had a fair bit to say too.

      • xoxozo

        Plus Roosevelts and more. Most Blacks don’t realize that Planned Parenthood was started to CONTROL the Black population.
        Just like the Unions, Progressivism started out for the right reasons BUT lost its way and got carried to far.
        It was also infiltrated by, IMO, socialists

      • rambler

        Progressives are commies with patience. I don’t believe that they have any good intentions. I believe that their intentions were to deceive the public.

      • xoxozo

        No they don’t have good intentions, if your read my words I said they, like the unions, STARTED out with GOOD purposes.
        In the early 1900’s they were the ones who helped the lower class. There was NO middle class, only the ULTRA rich & ultra poor.
        Henry Ford was the one who started the middle class by paying HIS employees $5.00 a day. It continued from there and lifted many poor up the ladder.
        Read ‘Fortune’s Children” and though I am a capitalist, it shows that PURE capitalism, like any form of PURE Gov’t is NOT GOOD.

      • rambler

        Unions may have started out with good intentions but the progressives did not. Their intentions were always to have one group controlling the rest of the people. The progressive programs were sold to the public with lies and deception, otherwise the public would not have agreed to any of it.
        Henry Ford paid his employees more because the high turn over of employees was costing him more money than he would lose by paying them more.
        In order for capitalism to work, there has to be competition. When that competition is suppressed by any sort of corruption, collusion or gov intervention, everyone loses.

      • rambler

        You might want to look at better historical reading material…. ones that are footnoted and referenced and not a semi-fictionalized account of the Vanderbilts which is sold at the Breaker’s gift shop. The Vanderbilts flaunted their money because they were not accepted by the old money which controlled most of society.

    • rs1123

      I always thought it was a very bad conflict of interest – how much money do they want to spend to keep you alive, when if you’re dead they don’t have to pay you anymore?

      • rambler

        Social security was originally designed to have people die before collecting or living long enough to collect very little.

  • PT

    Please say this isn’t so. obamacare was billed as the best thing ever for this country by those forcing it down American’s throats, not reading the bill. Thus I have a hard time believing this is the case, I’m sure it was a miswrite, period. The only thing left is for reid to call them a liar, and then exempt their own families from this.

  • walsall

    Well, someone didn’t get the memo…

    The right abandoned the ObamaCare horror story strategy two months ago. (That tends to happen after eight such stories in a row get publicly debunked.)

    You’re supposed to be onto Benghazi now. Benghazi, Benghazi, Benghazi.
    Get on board. You guys are 14% of the media. Without an effort thats concentrated and coordinated what chance do you have of making any progress?

    Benghazi, Benghazi, Benghazi!

    • xoxozo

      You got that right AND the VA the IRS. This is BY FAR the worse Pres we have EVER HAD except maybe for Wilson.

      Let’s get back to Owebamanocare and Bengazi OH WAIT you’re scared to find out the truth, so let’s make fun of it. Alinksy rules…
      Maybe if it had been your SON you might feel different.

    • rs1123

      This administration sucks the bag.

  • DaveBuc

    on a positive note, that will put all the hospitals in the country that treat elderly patients out of business.what is truly amazing is that these are the people who voted for the black Muslims.yet every time the Republicans tried to warn America about this the government run media proceeded to deny it and furthermore crucified Republicans.just think about it we will have gone from the best healthcare system in the world to one of the worst in just a short years. It is a true accomplishment.

  • http://newworldisland.blogspot.com/ Arnoldr

    Sure. “The government believes that if the correct treatment were administered during an initial hospital stay, these patients wouldn’t need to return.” We the people believe that the government is the problem, and IF the government was much less, or even not involved in the medical profession at all, then doctors would have the freedom to do as their oath requires: “do no harm.”

    • Had Enough

      Your partially right. As I say below it is all about greed too!!

  • Had Enough

    As a Nurse I agree with the statements made about wrong treatments being given and poor patient and family education given during the course of hospitalization. Drs. Vanity being involved in their decision on care hurts the patient more than anything, meaning when the patient doesn’t respond to the current course of treatment the Dr often becomes frustrated and will try something else, then when that treatment doesn’t work either rather than to get a second opinion he throws the patient on another course and tells the patient try this. I’m sending you home follow up with your primary Dr in the next week. There by washing his hands of this patient. If a patient is in the hospital for to long the Dr is called into admin office and scolded for the lengthy stay because the hospital isn’t being reimbursed enough . The Insurance company is badgering the Dr as well because their losing money on the patient. This has been going on for decades, I hate to side with obamacare , but this is nothing new folks!!! It all has to do with greed on the part of the hospitals and insurance companies. Unless we people stand as one and say we won’t take this anymore it will never change!!! There are thousands of frustrated Nurses in this country wanting to help the people but their hands are tied!!!

    • rs1123

      I would rather the doctor try three or four things, than to try one, have the guidelines say ‘that’s all you get’ and get sent home with nothing more.

      You’re a nurse? Hard to believe you cannot see how this is destroying healthcare and our hospitals.

      • Had Enough

        RS1123:of course I see the way healthcare is going. It’s ridiculous and shameful!!! I’m saying the gov. has no business sticking it’s nose in our healthcare!!! I was simply explaining what’s happening behind the scenes!!! Nurses care very much about our patients. We make a very strong bond with our patients!!! I have cross training in administration . I see those who were educated In business management pinching pennies because of the low reimbursement. I see the Nurses giving their all but struggling to find time to do more because insurance has decided to make a profit over adequate staffing :”. It all cost money and the greedy insurance companies now have obamas helping to limit reimbursement!!

  • xoxozo

    This IS THE POINT of Owebamanocare…EUGENICS!!! read about it. The Progressives have believed in it for 80+ years. G oo gle “george bernard shaw eugenics video” to see how it works

  • rs1123

    Typical of the government to make someone else do their dirty work. The ACA puts hospitals in the dilemma of a) do we readmit a patient in less than 30 days entirely at our own expense (when there is already NO money) or b) send them home to die?

    I work at a hospital and I have seen this coming. The government makes no allowance for someone whose treatment and physiology do not go 100% “by the book.” Very easy to tell OTHERS how to do THEIR job, when they suck at doing their own. Look how they run the VA.

  • nanblan

    Only more death panels to look forward to. Apparently the VA has been using them for quite awhile to decided which veterans can live and which veterans must die.

  • nanblan

    I recently learned that Obamacare is taking funds away from in-home care providers for the elderly and disabled in order to pay for his horrific program. Apparently thousands of these workers have already lost their jobs, and will have a hard time finding equivalent work as a result of the law.
    So there you have it – Obamacare is causing even more job losses, and it is, again, at the expense of the care of the elderly and disabled.
    Just another example of the many Obamacare death panels that we have yet to learn about.

  • KayDeeBeau

    So with the insight into how the VA administrators forged / de-frauded paperwork to qualify for bonuses at the expense of the lives of veterans, I am sure there is no “incentive” in the case of medicare patients to follow the same course? (sarc)

  • Rob Ca

    No surprise at all… Barry and his admin are heartless ghouls to the core.

  • 8FoldPath

    Thank you for the article, I feel validated because I’ve watched this scenario play out firsthand and knew there was something amiss. Elderly patients, Veterans and the Poor are not being treated the same as those with private insurance and the situation will only worsen. The plot all along has been to wean the masses off the government trough thereby killing two birds with one stone: lower the debt and depopulate the planet. It makes me wonder what they have in store for all those with EBT cards, Obamaphones and welfare…

  • Cindy Poole Wingenroth

    And perhaps if medicare would not force hospitals to push patients out the door before they are ready for discharge, readmission would not be such an issue as they would have time to adequately treat the patient on the first admission.
    On the brighter side, however, it may provide some incentive for healthcare institutions to provide better follow up for patients so that they can be effectively and safely managed out of the hospital setting.