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ames Breedin cannot keep track of how often he has been admitted to Howard University Hospital for heart problems. "It's been so many," said Breedin, a 75-year-old disabled former truck driver from Northeast Washington.
One reason for his frequent returns, he says, is that he often can't afford the medications his doctor prescribes to keep his heart problems in check, "so I have to do without." Another is that he fears exercising outside because of neighborhood violence.
Medicare is preparing to penalize hospitals with frequent potentially avoidable readmissions, which by one estimate cost the government $12 billion a year. Medicare's aim is to prod hospitals to make sure patients get the care they need after discharge. But this new policy is likely to disproportionately affect hospitals that treat the most low-income patients, according to a Kaiser Health News analysis of data from the Centers for Medicare & Medicaid Services.
Medicare Penalties For Readmissions Could Be A Tough Hit On Hospitals Serving The Poor - Kaiser Health News
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- Public Discussion (9)
This is going to be more of a major issue as the government tries to decrease the cost of Medicare payments. The main goal of any treatment and care of patients with chronic medical illness is to keep their illness under control by routine medical management and care on an outpatient basis by having a "medical home" that oversees their care. And in theory, it is a wonderful idea. We all know that ongoing preventive care is cheaper than being in the hospital or using the ER. But some particular patient populations will not be well served under this model unless drastic changes are made.
First of all you have to have enough doctors, office and clinic space to care for all these patients and often that infrastructure is not in place. In addition, the patient has to have resources to get their medications and treatments. You can write a prescription, but if the patient cannot afford the medication, well it won't do much good. The patients also have to have easy, available transportation to get to their doctor.
In addition, many of these patients lack the education and understanding of their illness and how their medications work. And it is often quite a challenge to educate them and it requires a lot of ongoing follow up to assure they are doing what they need to do. You also have to assure that the patient has what they need in their own home environment like electricity, running water, a place to live, a way to stay clean, and food to eat. If those things are not in place, the plan will not work. If they need assistance, do they have someone at home that can assist them with checking their blood sugar levels, eating, meal prep, taking their medications?
Hospitals and doctors cannot be punished for patients who fail to follow through. And sometimes no matter how you try, you will not get a person to be compliant with what they need to do to stay healthy.
- 1 vote
#1 - Wed Dec 21, 2011 9:50 PM ESTI an always looking for funny animal photos and she caught my eye. How are you grump?
RN,
I personally see real value in this law. As an RN I had my father in a hospital via paramedics that is noted to not be the best. He was in 3 days, the care and follow up was poor. He was discharged. There was no difficulty in obtaining medication or following instructions because he was with me, but he had to be readmitted to a different much better hospital, via the ER by me, and his condition was totally resolved.
Certainly there are hospitals where it's difficult to handle patient compliance but there are so many ways of dealing with it, that are dismissed by a discharge planner and the physicians. A friend of mine who's an intern on the east coast was complaining to me about a patient that was a return every month for CHF. I asked if they ever got a home health nurse involved, and of course the answer was no.
I worked for a time as a home health nurse and worked in poor and ghetto areas and there are things that nurses can do with social services, and working with a pharmaceutical company that can make a difference. Nurses can take the time to do more teaching, making medication charts, setting up weekly dispensers, monitor conditions more frequently that keep these people out of the hospital, and save the government a great deal of money.
The 'new' idea of this way of taking care of patients, well, it worked for my late husbands cousin here in KY and they're like Not Educated. They were assigned a social worker, a home health aid, a counselor and he had to go to a nursing home for a month to get him stablized. But he's in better shape than he's been in, in ten years and they did it in six months. Last I heard, they only have to have visits once a month and do the counselling once a month to keep them on schedules. He use to be in the hospital, two or three days, out couple weeks later, rotate back in etc.
Basically, they decide to move the savings of the hospital stays over to social care/temp nursing home care/home health care. So, I don't know if ...in the Long Run...there'll be any great savings, but more perhaps, healthier patients.
- 1 vote
#2 - Thu Dec 22, 2011 1:43 AM ESTThat, I think it the hope of the program. But there is a lot of diversity out there. Rural areas may fair better in some ways than inner city areas. It depends on the patients needs and the infrastructure in place.
In many ways, in smaller communities where people know each other in the community, it is easier. In my experience, people tend to keep an eye on each other more and they have more direct communication with the care givers at all levels. Because the communities are smaller, the case loads are often smaller. But when you get into large urban hospitals and clinic systems where there is more demand, people can get lost in the shuffle. It takes a lot of coordination and follow up to get people what they need.
I have worked in both environments in attempting to provide primary care and trying to keep people out of the ER and there are positives and negatives to both. And a big factor also is having a care partner in terms of a friend or family member who can assist the patient with coordinating care, especially if the patient suffers from an illness that might alter their mental status in some ways.
I believe the system can be successful if people are motivated to use it. I believe strongly that the more we can provide care to people close to their homes, knowing them and knowing what they are dealing with on a daily basis, the better the care will be.
I am very glad to know that the care was coordinated and provided to your late husbands cousin in a way that worked out well for him. That is so good to hear.
- 2 votes
Yep, we were astonished tooo.. He was about 6' and probably didn't weigh 100 lbs dripping wet. Both on SSI (for good reason, basically prenatal lack of nutrition ) and always broke. I think the main thing was they hired women that Knew what was what and how to handle the situation.
The town is about 20,000 give or take, but without a vehicle and no public transportation, some might as well live out in the back 40, thus the Call the Ambulance deal which ratcheted up the cost too. Sooo, the PAC's bus was put on alert, they got the low cost landline installed, his wife was taught to call PAC's. Small things like that made a huge difference.
They would listen to the relatives, and then couple weeks later back to the same old same old. I don't know what the social services said to them but whatever it was it worked. :)
- 1 vote
That is just great!! That is just how it should work for everyone. Have a wonderful holiday.
- 1 vote
Merry Christmas RNDiane, hope you and yours have a great Holiday and weekend. :)
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