for anyone who would like to read what the House bill actually says about incentives to reduce preventable readmissions of Medicare patients, see next comment. what Visiting Associate Professor of Philosophy, Politics, and Economics John D Lewis appears to have misread, and misinterpreted.
the language on readmissions is only meant to give hospitals a market-based incentive to reduce the number of PREVENTABLE readmissions. hospitals are pushed to do the right thing, i.e., not to discharge Grandma before she is ready to go home, and to make sure adequate support is in place so she will continue to get better at home -- not worse.
moreover, there are no government bureaucrats telling hospitals how to do so - that is left up to the individual hospitals. and there are no panels blocking the hospitalizations of individual patients -- those only exist in private insurance companies.
and the "Exclusions" section highlighted on Professor of Philsophy, Politics, and Economics Lewis's website -- that only means that if a hospital only has a small number of admissions in one of these categories, these will not be counted -- and the hospital not penalized. a measure like this helps protects smaller rural hospitals.
the bill, if one does actually read it, contains a lot of thoughtful provisions that try to make healthcare better. more thoughtful, anyway, than some of the criticism directed against it. i honor the right to oppose policy based on principles, but as a practicing physician who takes care of both veterans and hospitalized patients in a rural hospital, i wish we could think about what's best for patients -- and the current system ain't it.
SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS. (a) HOSPITALS.— (1) IN GENERAL.—Section 1886 of the Social Security Act (42 U.S.C. 1395ww), as amended by section 1103(a), is amended by adding at the end the following new subsection: ‘‘(p) ADJUSTMENT TO HOSPITAL PAYMENTS FOR EXCESS READMISSIONS.— ‘‘(1) IN GENERAL.—With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital under subsection (d) (or section 1814(b)(3), as the case may be) for such a discharge by an amount equal to the product of— ‘‘(A) the base operating DRG payment amount (as defined in paragraph (2)) for the discharge; and ‘‘(B) the adjustment factor (described in paragraph (3)(A)) for the hospital for the fiscal year. ‘‘(2) BASE OPERATING DRG PAYMENT AMOUNT.— ‘‘(A) IN GENERAL.—Except as provided in subparagraph (B), for purposes of this subsection, the term ‘base operating DRG payment amount’ means, with respect to a hospital for a fiscal year, the payment amount that would otherwise be made under subsection (d) for a discharge if this subsection did not apply, reduced by any portion of such amount that is attributable to payments under subparagraphs (B) and (F) of paragraph (5). ‘‘(B) ADJUSTMENTS.—For purposes of subparagraph (A), in the case of a hospital that is paid under section 1814(b)(3), the term ‘base operating DRG payment amount’ means the payment amount under such section. ‘‘(3) ADJUSTMENT FACTOR.— ‘‘(A) IN GENERAL.—For purposes of paragraph (1), the adjustment factor under this paragraph for an applicable hospital for a fiscal year is equal to the greater of— ‘‘(i) the ratio described in subparagraph (B) for the hospital for the applicable period (as defined in paragraph (5)(D)) for such fiscal year; or ‘‘(ii) the floor adjustment factor specified in subparagraph (C). ‘‘(B) RATIO.—The ratio described in this subparagraph for a hospital for an applicable period is equal to 1 minus the ratio of— ‘‘(i) the aggregate payments for excess readmissions (as defined in paragraph (4)(A)) with respect to an applicable hospital for the applicable period; and ‘‘(ii) the aggregate payments for all discharges (as defined in paragraph (4)(B)) with respect to such applicable hospital for such applicable period. ‘‘(C) FLOOR ADJUSTMENT FACTOR.—For purposes of subparagraph (A), the floor adjustment factor specified in this subparagraph for— ‘‘(i) fiscal year 2012 is 0.99; ‘‘(ii) fiscal year 2013 is 0.98; ‘‘(iii) fiscal year 2014 is 0.97; or ‘‘(iv) a subsequent fiscal year is 0.95.
‘‘(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.
Great show billlumaye! I'm listening from Boston MA. That guy John Lewis is a real hero. Bring him back and find out where gets his brain food. Solid!
ReplyDeleteMark Dohle
for anyone who would like to read what the House bill actually says about incentives to reduce preventable readmissions of Medicare patients, see next comment. what Visiting Associate Professor of Philosophy, Politics, and Economics John D Lewis appears to have misread, and misinterpreted.
ReplyDeletethe language on readmissions is only meant to give hospitals a market-based incentive to reduce the number of PREVENTABLE readmissions. hospitals are pushed to do the right thing, i.e., not to discharge Grandma before she is ready to go home, and to make sure adequate support is in place so she will continue to get better at home -- not worse.
moreover, there are no government bureaucrats telling hospitals how to do so - that is left up to the individual hospitals. and there are no panels blocking the hospitalizations of individual patients -- those only exist in private insurance companies.
and the "Exclusions" section highlighted on Professor of Philsophy, Politics, and Economics Lewis's website -- that only means that if a hospital only has a small number of admissions in one of these categories, these will not be counted -- and the hospital not penalized. a measure like this helps protects smaller rural hospitals.
the bill, if one does actually read it, contains a lot of thoughtful provisions that try to make healthcare better. more thoughtful, anyway, than some of the criticism directed against it. i honor the right to oppose policy based on principles, but as a practicing physician who takes care of both veterans and hospitalized patients in a rural hospital, i wish we could think about what's best for patients -- and the current system ain't it.
as promised:
ReplyDeleteSEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS.
(a) HOSPITALS.—
(1) IN GENERAL.—Section 1886 of the Social Security Act (42 U.S.C. 1395ww), as amended by section 1103(a), is amended by adding at the end the following new subsection: ‘‘(p) ADJUSTMENT TO HOSPITAL PAYMENTS FOR EXCESS READMISSIONS.—
‘‘(1) IN GENERAL.—With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital under subsection (d) (or section 1814(b)(3), as the case may be) for such a discharge by an amount equal to the product
of—
‘‘(A) the base operating DRG payment amount (as defined in paragraph (2)) for the discharge; and
‘‘(B) the adjustment factor (described in paragraph (3)(A)) for the hospital for the fiscal year.
‘‘(2) BASE OPERATING DRG PAYMENT AMOUNT.—
‘‘(A) IN GENERAL.—Except as provided in subparagraph (B), for purposes of this subsection, the term ‘base operating DRG payment amount’ means, with respect to a hospital for a fiscal year, the payment amount that would otherwise be made under subsection (d) for a discharge if this subsection did not apply, reduced by any portion of such amount that is attributable to payments under subparagraphs (B) and (F) of paragraph (5).
‘‘(B) ADJUSTMENTS.—For purposes of subparagraph (A), in the case of a hospital that is paid under section 1814(b)(3), the term ‘base operating DRG payment amount’ means the payment amount under such section.
‘‘(3) ADJUSTMENT FACTOR.—
‘‘(A) IN GENERAL.—For purposes of paragraph (1), the adjustment factor under this paragraph for an applicable hospital for a fiscal year is equal to the greater of—
‘‘(i) the ratio described in subparagraph (B) for the hospital for the applicable period (as defined in paragraph (5)(D)) for such fiscal year; or
‘‘(ii) the floor adjustment factor specified in subparagraph (C).
‘‘(B) RATIO.—The ratio described in this subparagraph for a hospital for an applicable period is equal to 1 minus the ratio of—
‘‘(i) the aggregate payments for excess readmissions (as defined in paragraph (4)(A)) with respect to an applicable hospital for the applicable period; and
‘‘(ii) the aggregate payments for all discharges (as defined in paragraph (4)(B)) with respect to such applicable hospital for such applicable period.
‘‘(C) FLOOR ADJUSTMENT FACTOR.—For purposes of subparagraph (A), the floor adjustment factor specified in this subparagraph for—
‘‘(i) fiscal year 2012 is 0.99;
‘‘(ii) fiscal year 2013 is 0.98;
‘‘(iii) fiscal year 2014 is 0.97; or
‘‘(iv) a subsequent fiscal year is 0.95.
‘‘(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.