Proposed Medicare Cost Reductions an Exercise in Self-serving Behavior

Caregivers’ perspective ignored

One proposed strategy to lower Medicare costs is to reduce the number of rehospitalizations. Armies of policy advisors and consultants have been deployed to present at conferences and testify at hearings to explain the problem and offer solutions—more of the former than the latter. An aside: I know they are not doing this for free. Who is paying these people? Politicians, health care experts, and hospital administrators talk to each other as if no one else is in the room.

Rehospitalization is the term Medicare uses to describe the process of patients returning to the hospital, within a year, for the same problem for which they were admitted in the first place. Proposed health care reform anticipates billions (that’s b for billons) in savings by reducing the number of rehospitalizations. Rehospitalization rates are shockingly high.

According to Arnold Epstein, MD, MA (“Revisiting Readmissions – Changing the Incentives for Shared Accountability”), among Medicare recipients, about 20% of patients are readmitted within 30 days and 56% are readmitted within a year. More have not been readmitted because they have died within a year of discharge. Rehospitalization rates differ from city to city. Rates in San Jose are significantly lower than rates in Washington, DC.

Largely, hospitals have been identified as the culprits. Inadequate coordination of care within hospitals, poor discharge planning, insufficient follow-up by primary care physicians after discharge, and medication mismanagement are often cited as reasons for frequent rehospitalizations.

So what’s the proposed fix? You guessed it. Give the hospital more money to coordinate care once the patient leaves the hospital; and as an incentive, if the patient is not rehospitalized, let the hospital keep the money that is not spent. Brilliant.

Truth: Family caregivers are the real care coordinators. They perform the lion’s share of care coordination with no reimbursement and without preparation, tools, or support. Most unfortunately, health care/Medicare reform only begrudgingly includes caregivers in the discussion.

One solution? Care Transition Intervention, developed by Eric Coleman, MD, MPH, of the University of Colorado at Denver. Dr. Coleman knows that hospital patients are not discharged into “the ambulatory setting,” as health policy planners like to call it; rather, most elderly patients are discharged to caregivers. The Care Transition Intervention program offers specific tools to patients and caregivers, along with help from a “transition coach” to learn self-management skills that will ensure an as-smooth-as-possible transition from hospital to home. The program focuses on effective use of medications, timely primary care follow-up, knowledge of red flags that indicate a worsening condition (and how to respond), and use of a Personal Health Record.

While Dr. Coleman’s program is not the only answer to the problem, a sole solution involving greater hospital involvement with patients, not less, clearly demonstrates how out of touch and self-absorbed some proponents of health care reform have become.

By Sara Myers
A Good Enough Daughter Blog