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Changes in Hospitals’ Treatment of Medicare Patients (Part 2)

Last week we were talking about Medicare’s Affordable Care Act and how the government is trying to reduce Medicare costs by targeting the problem of readmissions.  Beginning last October, Medicare began penalizing hospitals for having too many readmissions.  So, what has the impact been in New Jersey over the past 9 months or so?

A recent study by Healthcare Quality Strategies, a firm hired by the federal government, showed that, at the end of 2012 the rate of Medicare patients readmitted to New Jersey hospitals within 30 days had dropped by 7.5%.  While this number clearly is an improvement, it can’t be a result of the Affordable Care Act, since the law only became effective in the last 3 months of the 2 year period during which the decline occurred.

Nevertheless, the consensus at this point seems to be that the Act will have a continued impact on readmission rates.  The theory is that hospitals and their discharge planners will work more closely with assisted living facilities, nursing homes, subacute rehabilitation facilities, home care agencies, doctors, nurses, hospice providers, pharmacists, mental health providers and others to insure better care for their patients after they leave the hospital.  If the follow up care improves, the less likely the hospital is to see the patient back in its facility any time soon.

In speaking with a number of people at assisted living facilities in my area, several have reported that the number of potential residents they have seen coming from rehab facilities in recent months has dropped.  Some believe that could be because the number of patients leaving the hospital for the rehab facilities has dropped.  It is hard to verify this without having access to the actual numbers but if true, it would run counter to what supporters of Affordable Care insist will occur.

There could be other factors at play.  It is possible that hospitals are not as willing to admit patients since the Affordable Care Act became effective.  They could be lowering their readmission rates by not admitting certain patients the first time, instead sending them home.  This is probably not what the Act intended and may instead, eventually drive some people back to the hospital with more serious conditions.  It just may be a matter of waiting a sufficient amount of time to see the effect.

It is still too early to tell at this point what effect the Affordable Care Act will have.  It is also too early to determine if there is a shift in how patients will find the long term care services they need and whether hospitals, medical and long term care providers will be working more closely as Medicare seems to expect.  One thing, however, remains clear.  The number of people in this country needing long term care services will continue to grow.  How they find those services and pay for them may change but the basic need isn’t going to decline any time soon.