ObamaCare has hurt family budgets, patients seeking care and even hospitals. A study from none other than Harvard Medical School “found that safety-net hospitals that treat many low-income or uninsured individuals are being penalized more for hospital readmission rates than other hospitals.”
These hospitals are the institutions that were supposed to help provide ObamaCare enrollee with the care they need, and be rewarded for providing that access. Instead, as the Washington Examiner puts it, this is “the latest evidence of problems with the law’s effort to improve quality of care.”
Here’s the problem:
If a hospital readmits too many patients 30 days after they are discharged after being treated for a certain condition, that hospital gets penalized. A hospital could receive up to a 3 percent reduction in its Medicare annual patient payments.
This portion of ObamaCare is a policy that was implemented in 2011 and “is intended to address a quality issue at hospitals.” One of the goals of the legislation was to change the payment process for health care providers from a fee-for-service model to a system that rewards quality of care. As with most government attempts to regulate an industry, there are some serious unintended consequences.
The Harvard study says that “Hospitals with high readmission rates may be penalized to a large extent based on the patients they serve.” If these facilities are treating patients who haven’t had insurance, and thus need more care than a typical patient, then they are being hurt by the very population they serve.
In essence, “Hospitals that serve sicker patients are more likely to have readmissions.” That means that safety-net hospitals, which are by definition a safety-net for those who can’t afford access to more advanced medical centers that some have access to, are disproportionately impacted by this policy.
Dr. Michael Barnett of Harvard Medical School, who authored the school’s study, told the Washington Examiner that “By penalizing these hospitals more severely it could potentially exacerbate [health] disparities because these are the hospitals that have the least resources.”
The study says that the way quality of care is measured needs to be adjusted and suggests several alternatives.
One alternative would have a hospital be measured by how its readmission rate improves rather than whether it meets a national average.
“Hospitals could be rewarded based on improvements off what their prior performance has been,” Barnett said.
Another alternative is for a hospital to become an accountable care organization. The concept gives a hospital a spending growth target that it has to meet for its Medicare patients.
If spending is less than the target, the hospital has to share some of the savings with the federal government, Barnett said.
The study also notes that any reforms must ensure “that people won’t be able to game the system.” As the Examiner reports, “Some studies have found that hospitals are trying to find ways to avoid listing readmissions. For instance, hospitals are increasingly “observing” discharged Medicare patients who return to the hospital, rather than readmitting them. Observing a patient means the patient gets the same care, but the hospital doesn’t have to readmit him.”
Predictably, there is a negative effect on the patient when hospitals act this way. The observation strategy “can increase the patient’s out-of-pocket costs because observation status is often classified as outpatient services, according to an article in the journal Health Affairs.”
Without changes to ObamaCare’s quality metrics system, safety-net hospitals will continue to be penalized for treating the poorer and sicker patients that need their services, and will likely find ways to avoid that financial hit by exploiting loopholes that may very well harm their patients.