An increasing number of patients are visiting outpatient surgery centers for procedures and surgeries that in earlier years would have required a stay in the hospital.
As a result, hospital stays are getting shorter.
“The basic model for outpatient surgery has gone from lumps and bumps to a growing number of procedures that not very long ago required an overnight stay,” said Dianne Taylor, editor of Outpatient Magazine.
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As a case in point, we have all marveled at how new mothers and their just-born infants are released from the hospital these days often within 24 hours of birth, while in decades past women who had given birth would have stayed in the hospital post-delivery for five days or more.
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New, minimally invasive technologies such as laser and laparoscopic surgery, as well as advances in anesthesia, have turned hospital recuperations into home recuperations. The patient is up and moving at ever-increasing speeds.
Aside from their first mission of caring for their patients, hospitals now have to make sure patients don’t have to be readmitted after a hospital stay, thanks to the Affordable Cart Act.
Another reason surgeries have become outpatient procedures is “budgetary pressures,” said Taylor. But why would budgetary pressures impact methods of surgery? And what if a patient has surgery done on either an inpatient or outpatient basis but needs to be admitted to a hospital because of complications?
Aside from their first mission of caring for their patients, hospitals now have to make sure patients don’t have to be readmitted after a hospital stay, thanks to the Affordable Cart Act.
Almost 2,600 hospitals have lost a combined $420 million in Medicare payments in the latest round of readmission penalties.
American hospitals are in the fourth year of government readmission policies. Beginning in October, they will receive lower payments for every Medicare patient that stays in the hospital – readmitted or not. The Hospital Readmission Reduction Program, created as a mandate of Obamacare, is in theory a way for hospitals to keep closer tabs on their patients after they are discharged.
Hospitals that are levied the maximum readmission penalties are in economically challenged areas of the country.
This Obamacare punishment has worked, so far. Since the fines began, national readmission rates have dropped by 70 percent.
What do the medical professionals in charge of patient care have to say about this?
“The evidence suggests that a discharge plan tailored to the individual patient probably brings about reductions in hospital length of stay and readmission rates for older people admitted to hospital with a medical condition,” Dr. Ramin Oksaui, president of the medical staff at Sibley Memorial Hospital in Washington, D.C., told LifeZette.
Patients, however, can pay the price.
“This is part of a trend in which medical providers, including hospitals, are defending themselves against regulators, often at the expense of patients,” Grace-Marie Turner, president of the Galen Institute, a public policy research organization that focuses on health care issues, told LifeZette.
Hospitals that are levied the maximum readmission penalties are in economically challenged areas of the country. Kaiser Health Network said two of the hospitals that were fined are in the heart of Kentucky’s coal county. Another is in Winnsboro, Louisiana, while another is in Livingston, Tennessee.
Sen. Joseph Manchin III, D-W. Va., and Sen. Roger Wickers, R-Miss., co-authored a piece addressing the Medicare penalties along with health policy analyst Dr. Andrew Boozary, which was published in the Journal of the American Medical Association.
“Hospitals should not be penalized simply because of the demographic characteristics of our patients,” the three authors wrote.
Hospitals have been lobbying to make changes to these penalties.
The trio also said that so-called “safety-net hospitals” — a hospital or health system that provides a significant level of care to low-income, uninsured, and vulnerable populations — were almost 60 percent more likely than other hospitals to have been penalized in the first three years that penalties were levied.
They also wrote that hospitals with the lowest profit margins were 36 percent more likely to be penalized than those in better fiscal shape.
Hospitals have been lobbying to make changes to these penalties, asking both Medicare and Congress to factor in the socio-economic backgrounds of patients served when assessing readmission penalties.
They argue that factors such as whether patients can afford healthy food and medications should be considered. Other health care entities such as the Medicare Payment Advisory Commission and the National Quality Forum, a nonprofit group, also say that socio-economic factors should be considered when looking at readmission requirements, along with other measures of hospital quality.
The bottom line?
“Outpatient surgery is a good development if driven by patient preferences and newer technologies,” Turner said. “But it’s bad if medical providers are catering to regulators to keep themselves out of legal and financial trouble, often without regard for what is best for patients.”
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