Hospitals Want to Keep You From Boomeranging Back In

Hospitals have a new incentive to help keep you from boomeranging back to them shortly after you’ve been sent home or to another care facility.

Starting in October, general hospitals will begin losing a portion of their Medicare payments if too many patients are readmitted within 30 days of being discharged for pneumonia, heart failure or heart attack, according to a provision in the health-care law.

More than 2,200 hospitals are affected this year. Medicare payments to hospitals will be reduced by 0.3%, or nearly $300 million, says Nancy Foster, vice president for quality and patient-safety policy for the American Hospital Association, a trade group in Washington.

The rules are designed to improve health-care quality and lower costs for Medicare beneficiaries. The penalties and list of applicable conditions are set to expand over time. Some private insurers also are demanding more accountability instead of automatically paying for readmissions due to things like infections and poor care coordination.

“Readmissions happen for many reasons,” says David Bronson, president of the American College of Physicians and an internist at the Cleveland Clinic in Cleveland, Ohio. “What we’re trying to reduce are the ones that could [have been] prevented if we’d planned better.”

Nearly one in five Medicare enrollees are readmitted to a hospital within 30 days of their initial stay, accounting for an estimated $15 billion in annual spending, according to a 2007 report from the Medicare Payment Advisory Commission, a nonpartisan government agency that advises Congress about Medicare.

In general, hospitals are responsible for 80% of what drives their readmissions, while lack of patient compliance accounts for 20%, says Rich D’Alberto, chief executive of the Laurens County Health Care System in Clinton, S.C.

Of course, newly discharged patients can’t always avoid re-hospitalization. But there are things you or a trusted surrogate can do to lower your chances, according to doctors and hospital administrators.

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