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Boston and Beyond

September 15, 2013

Hospitals pay price for 'excessive' readmissions under Obamacare

(Continued)

“If we have less income, we can’t invest in necessary equipment. We’ll be forced to reduce programs and services,” Klugmen said.

Toby Edelman, a senior policy attorney for the non-profit Center for Medical Advocacy in Washington, DC, says Medicare’s mandate may also be too daunting for some hospitals, forcing them to look to alternative measures to meet the government’s new standards.

To skirt Medicare’s readmission rules, she said, more hospitals may begin classifying returning patients as “outpatients” even though the patients may spend the same amount of time in the hospital and get the same tests, medications and other care given to admitted patients.

The problem with outpatient status, however, is that patients who need additional care outside of a hospital-- in a nursing home for example-- may end up paying for that care out of their own pocket since Medicare reimburses for outside costs only when admitted patients transition into a nursing home or rehabilitation center setting, Edelman explained. Patients classified as “outpatients” just don’t qualify.

Take, for example, the 86-year-old woman who was listed as an outpatient during her hospital stay and ended up with a nursing home bill of more than $17,000. Another family cashed in an elderly relative’s life insurance policy to pay for nursing home care after their loved one was hospitalized as an outpatient instead of being listed as admitted.

“It’s very frightening,” said Edelman. “People assume when they’re in a hospital bed they’re an admitted patient. (But) a lot of people are listed as observation status for much of their stay.”

Yet, hospitals say they are making progress.

At Beth Israel Deaconess and at other medical facilities, new programs are being implemented that help Medicare patients deal with their own healthcare after they are discharged. By hiring nurses to check on patients, forging partnerships with doctors, nursing homes and other facilities and installing software that can predict which patients will need more help after leaving the hospital, Beth Israel Deaconess has cut readmission rates by between 15 and 20 percent, Sands said.

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