Hospitals Work To Reduce Readmissions - Payers are the Ones Benefiting and some Hospitals Actually Lose Money Providing Better Care…

Sounds similar to the investment in technology for doctors, hospitals having the same issue with the insurance companies reaping the rewards. One comment below leaves a question in my mind though, how does one “guarantee” that a patient will not need to be re-admitted? I would think each individual patient case would have to be examined to determine when a “guarantee” can be given? Stated below the payments are made based on treatments provided and not the health of the patient, so again the “guarantee” question.

Software and business intelligence systems help hospitals analyze how they are doing business and it is an investment that can be costly and with today’s economy with admissions being down percentage wise, where is the incentive? One hospital in Texas asked that the ER Department work on admissions since they were down and brought the levels up a notch, and then were fired for admitting patients who they felt due to business intelligence analysis reports that should not have been admitted.

Hospital Admissions are Down – ER Doctors are Fired – Texas Medical Association

This is a very confusing scenario, to admit or not to admit appears to be the question, and with little or no compensation for the efforts. BD

Hospitals' efforts to reduce the portion of patients who are readmitted for follow-up care are proving successful in many cases, but even though the moves often result in savings for insurers, the hospitals do not necessarily benefit financially, the New York Times reports. Because insurer payments are based on treatments provided rather than the health of patients, hospitals can "actually lose money by providing better care," the Times reports.
Robert Berenson, a policy specialist for the Urban Institute, said, "The hospitals who say they are penalized for doing the right thing are absolutely right." He added, "If we can't do this, we can't do much of anything in health reform." Harold Miller, executive director for the Center for Healthcare Quality and Payment Reform, said, "The payer reaps the entire benefit" of more effective care.

According to Miller, there are payment models that allow hospitals to benefit from these savings or even receive extra payments for guaranteeing that patients will not need to be readmitted.