Tuesday, August 11, 2009

Readmission Savings

President Obama today:
Right now hospitals, they are not penalized if there are constant readmission rates from patients that have gone through the hospital. If you go to a — if you go to a car company or a auto shop, if you say, “Can I have my car repaired?”, you get your car repaired — if two weeks later it’s broken down again, if you take it back, hopefully they’re not going to charge you again for repairing the car. You want them to do it right the first time. And too often we’re not seeing the best practices in some of these hospitals to prevent people from being readmitted. That costs a lot of money. So those are the kinds of changes we’re talking about.

Amen. It's like when I buy a Chalupa at Taco Bell and I get home and it's too cold or there's not enough lettuce in it or the sauce is leaking out the back. So then all I have to do is bring it back and they give me another piping hot, non-leaky chalupa for free. I mean, I already spent 89 cents. Why should I spend another 89 cents when they didn't do it right the first time.

Or if I get a haircut and when I get home, my wife tells me I look like they hacked at my rats nest with a dull lawnmower blade, all I have to do is go back and they fix it for free. I mean they didn't do it right the first time. Why should I pay them again?

I don't get these hospitals and doctors. You mean to tell me a human being is more complex than a chalupa? Or a bad muffler? You gotta be kidding me. And I don't want to hear about how some patients are only approved by Medicare or their insurance company for a three day admission. You can always lie, right? Just write in the chart something along the lines of "patient still inexplicably not 100% healthy, need at least another week in the hospital". It's so easy. You'd think these doctors and hospital CEO's with their fancy degrees would have figured it out by now.


HMS said...

There is no doubt a [widening] chasm between politics and medicine.

The only way out of readmission cycle is a more robust primary care & public health infrastructure.

Where else should the patient go if his/her chronic condition keeps, well, "acting out"? It's not as if physical aliment is simply an occasional annoyance of the day.

joegrind said...

....or when someone 'misplaced' that 4X4...gotta get the count right..the first time!

Anonymous said...

You voted for him, or at least your state did, but hey, doesn't he talk good???


Anonymous said...

The insurance lobby has this thing locked up.

Insurance company standard procedure: Wait till patient becomes emergently ill before allowing definitive diagnostics in effort to delay/avoid treatment, and then push for early discharge even though the patient is still in danger. This is why patients require readmission. This is why insurance companies compound cost and then place blame on doctors and nurses. Their attempts to globally avoid payouts often blows up and someone else gets to take the blame. Oh, forgot to mention the bill, yes, the bill. Somewhere 20 years ago there was an elevated WBC, so claims will be denied due to preexisting condition and the patient will go bankrupt.


Anonymous said...

Try buying Taco ingredients separately and make them yourself, doc :) 100% satisfaction guaranteed.

Frank, there simply weren't any one else on the ballot who could deal with issues as complex as health care reform. The problem wasn't created overnight; it surely can't be solved overnight. Keep your expectation in check, will you?

HudsonMD said...

Here's what we see in practice with these "re-admission patients". To use Obama's car example: Car brought to body shop and fixed adequately. then can shows up again three days later with similar damage from accident. Car fixed again and sent out of body shop with instructions on how best to avoid another accident. But returns again a week later with similar front-end damage just like before after refusing to follow the instructions. Or how about the car that just feels better in the body shop because the technicians do everything for them...etc.... I think you see the point. Not all re-admission problems are physician or institution isues

Unknown said...

For a second, I thought you weren't joking. (Yikes! Isn't that scary, when the popular rhetoric gets so screwed up that you can't even tell if someone is being sarcastic or not?)

I don't work in medicine. (But I read this blog, because I'm a writer, and as such, I find the posts fascinating.) But for decades I designed computer software. And even in the software-development industry, most consultants charge by the hour, and if you have to hire them again and again to fix the same thing, as it were, them's just the breaks, because let's face it: software is complicated.

But no one's implying that the human body is more complex than a lousy piece of computer software. (Ba dum bum.)


rrs said...

keep blogging. this is one of the few places which make me believe rationality still exists.

Anonymous said...

Buckeye - have to disagree with you on this one (although I do agree that a patient is more complex than a chalupa). 20% readmission rates for Medicare patients within 30 days is not acceptable. Often, it is due to errors in the system that need to be addressed: that follow-up nurse or PCP visit that doesn't happen, the CHFer who maybe needed another day of diuresis to delay the next exacerbation, etc. Coordinated, systematic improvements in discharge planning would make a big difference. Just think about your Cook County patient population...