Medicare advantage

Medicare Rules Alter Hospital Admission Stats

According to a recent analysis of health data conducted by the Wall Street Journal, there are some shifts in hospital trends in light of recent Medicare rules. According to the data, evaluated from Banner Health’s general hospitals, heart-failure patients who end up being admitted to the hospital again are decreasing drastically. The same is true for patients treated for several other serious conditions, including pneumonia.

Causes of the Results

According to the Obama administration, this trend is a result of the fact that the federal healthcare reform penalizes hospitals that have high readmission rates for the 30-day period after a patient stay. The goal of this penalty system is to encourage solid follow-up treatments outside of the hospital so that patients don’t have to return. The ultimate goal of this is to promote better patient health and also keep government costs down.

Is There More to the Story?

According to Banner, though, these statistics alone do not tell the whole story. More patients are re-entering hospitals around the country on “observation status”, a category that does not technically count as a readmission. The care given to a patient on observation status might be identical to that offered to a readmission case, thus allowing a patient to stay in the hospital for days but avoid being calculated in the penalty classification. While observation stays are typically cheaper for the government, it is still troubling that a trend may be emerging encouraging hospitals to skirt the rules while not addressing the primary concerns of the purpose behind the penalty.

The fact is that observation status indicates that the data may be skewed and that issues associated with readmissions are still cropping up, just in the form of a new status classification at the hospital itself. CMS has, in the last few years, encouraged hospitals to make use of observation status more often through the advice of auditors who review claims for the agency. According to hospital executives, this advice is part of the reason why observation stays are up.

It’s clear that there are more issues going on than meets the eye, but it’s not entirely clear about the causality behind decreased readmission and higher rates of observation stays. To stay tuned for more information about the healthcare industry impacting seniors, follow Senior Health Solutions LLC., or contact us by phone at (636) 244-4415 or online.

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