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Readmissions: Stacking the Deck

Gentrify: To change (a place, such as an old neighborhood) by improving it and making it more appealing to people who have money.

A FierceHealthcare article (“CMS penalties may stack deck against minority-serving hospitals”), along with data showing that 72 hospitals, primarily serving the poor and elderly in rural America, have closed their doors since 2010,2[http://kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/], leads me to construe that the gentrification of the American healthcare system is perhaps one of the unintended consequences levied by CMS readmission penalties. 

The article specifically cites the results of a study led by Waddah B. Al-Refaie, M.D., chief of surgical oncology at MedStar Georgetown University Hospital, which found that while they measured “30-day readmission rates of 11.6 percent … across all the hospitals studied, the rate was higher–13.6 percent–among minority-serving hospitals.” In addition, by extending the readmission period to 90 days, the study indicates an even wider gap, with “17.4 percent of patients readmitted overall and 20.1 percent of patients readmitted at minority-serving hospitals.” By digging more deeply into the data, the researchers determined that “patient factors beyond the hospital’s control, such as income, race, and whether [the patients] were insured, comprised an increased risk of readmission of as much as 65%.”
The article does credit that CMS officials have recently recognized these limitations and are exploring how such socioeconomic factors, many of which are outside of hospital control, impact its current penalty calculation methodology. Alas, the ancient aphorism of the Roman playwright Publius Terentius Afer holds true today: “How unfair the fate which ordains that those who have the least should be always adding to the treasury of the wealthy.”

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Readmissions: The Death Penalty

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A recent FierceHealthcare article suggests that, in addition to the 30-day readmission penalties imposed by CMS, the agency should begin to levy penalties for 30-day post discharge mortality rates. The article cites heart failure cardiologist and senior study author Scott Hummel, M.D., who observed that “Under most circumstances, hospital patients would much rather avoid death than readmission. But the incentive to prevent death in the first 30 days after a hospitalization is 10 times less than the incentive to prevent a return hospital visit.”

Frankly, I’m confused. Are the authors of the study suggesting that hospitals are “preventing” patient readmissions to the point of negligent homicide? That would be crazy! The basic assumption drawn from the study seems to be that patient mortality within 30 days of discharge indicates a lapse in care quality and should therefore be included in the care quality metric used to calculate penalties. What if I get hit by a bus on day twenty-nine post discharge? Does that factor in as well? Any traction found by this idea will certainly favor CMS, according to author Morrie Schwartz who observes: “Everything that gets born dies.”

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