Doctors pressured to fill the beds:
Source: CBS News.
Doctors pressured to fill the beds:
Source: CBS News.
In recent years, hospitals have become increasingly open with patients: over 80 percent of hospitals in my study have a policy of apologizing to patients when errors occur. And hospitals are more willing to discuss and learn from errors with hospital staff.
Here is more.
A RAND Health study found that hospital emergency rooms are now the point of access for nearly half of all hospital admissions in the U.S. and account for almost all of the growth in admissions between 2003 and 2009. During that time, hospital admissions grew only 4% — not even keeping pace with population growth. But ER-related admissions jumped 17%. (ModernPhysician.com)
Why this is important: about half of the newly insured under ObamaCare will get insured by Medicaid, and Medicaid patients use the emergency room twice as often as privately insured patients. Also, hospitals are buying doctors, who will be pressured to admit patients once they get to the emergency room.
A surgical complication increases a procedure’s average contribution margin by 330 percent for the privately insured and 190 percent for Medicare patients, according to a study published this week in the Journal of the American Medical Association…
When a surgical complication occurred, the profit margin jumped from $16,936 to $55,953. For Medicare patients, profits grew from $1,880 to $3,269.
HT: Sarah Kliff.
Go to the Web site of any publicly traded profit-making corporation — e.g., the Hospital Corporation of America — and click on the tab “Investor Relations.”
You will find tabs for annual reports to shareholders and the mandatory filings made to the Securities and Exchange Commission. Among them are 10-K’s, annual reports that are detailed and audited. There is also great detail on the criteria by which executive performance is evaluated by the board of directors, along with dollar figures of actual compensation paid.
Is there anything like this transparency and public accountability in the nonprofit sector? Indeed, who actually owns these entities? To whom do they render account for the sizable real resources and finances under their control? And what benefits do they deliver in return for the exemption from income taxation they enjoy?
Approximately 1,500 hospitals nationwide are known as “safety net” providers because they care for a larger portion of uninsured patients than their competitors…
A report released Tuesday by the private consulting firm Alvarez & Marsal warned that the health care law “may actually worsen the status of many safety net hospitals.”
First, the law slows the rate of regularly scheduled pay bumps from the federal government, meant to help hospitals keep pace with growing health care costs…
Safety net hospitals also will bear the brunt of cuts in “disproportionate share payments,” money that the federal government sends hospitals that cover a high level of uninsured patients. These payments, which come from the Medicaid and Medicare programs, will fall by more than $30 billion over the next decade…
Last, the health care law tethers a small portion of hospitals’ Medicare payments to the quality of care they provide and to patient satisfaction rankings. If hospitals don’t hit certain targets, they stand to lose 1 percent of their Medicare income. Safety net hospitals, separate research suggests, may have a tough time hitting the goals, because they tend to receive lower patient satisfaction ratings than competitors who treat fewer uninsured people.
This is all from Sarah Kliff.
One hospital group encouraged its docs to exaggerate the severity of patient conditions and needlessly admit patients from the ER to hospital beds in order to bill more for their treatment. Another hospital group that owns three hospitals and also partially owns an ambulance company was making patient transfers (using their own ambulance company despite slower response times) a top priority — to the extent that a doctor’s transfer rate was a factor in bonuses and performance reviews. An admin email stated that “the performance we are looking for are transfers.”
This is from Roy M. Poses.
Based on a 20 percent sample of Medicare claims from 1985-2005 for people 65 and older, Brauer et al. 2009 provide data on length of hospital stay for people with hip fractures in the U.S.
The median length of stay for hip fracture over the period decreased from 12 days to 5 days. Risk-adjusted mortality at 30, 180, and 360 days improved for both men and women:
Source: Carmen A. Brauer et al. 2009. “Incidence and Mortality of Hip Fracture in the United States,” JAMA, 302, 14, 1573-1579.
Innumerable studies in the health care literature use reduction of days in hospital as a measure of reduced costs. Unfortunately, the simple reduction of days in hospital and death rates, while welcome, tells us little about readmissions, total costs, or extent of recovery.
With the passage of DRG reimbursement in 1983, hospitals began adjusting their business models to accommodate flat rate payments. One outcome was “quicker but sicker” discharges. In 1986-88, the paper notes that 34.3 percent of hip fracture patients went home with self-care and 33 percent were discharged into skilled nursing facilities. By 2003-05, only 5.3 percent of patients were discharged home with self-care. The majority, 52.9 percent, were discharged to a skilled nursing facility.
And Medicare is the only reason they exist. From Kaiser Health News:
For 15 years, Congress has bestowed special privileges to some small remote hospitals, usually in rural areas, to help them stay afloat. Medicare pays them more than it pays most hospitals and exempts them from financial pressure to operate efficiently and requirements to reveal how their patients fare. Nearly one in four hospitals qualifies for the program.
Despite these benefits, there’s new evidence that the quality of many of these hospitals may be deteriorating. A study published Tuesday found that during the past decade the death rates of patients at these critical access hospitals were growing while mortality rates at other hospitals were dropping.