Medicare Changes: What You Need To Know Now

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance
Article Date: 28 Jun 2012 – 1:00 PDT

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Today, many hospitals are filled to capacity, and as a consequence, physicians are continually pressured to discharge their patients as quickly as possible. Because of inefficiencies in how they communicate with case managers, nurses, and patients, patients are frequently discharged with many loose ends.

Recognizing these realities, the new Medicare reimbursement rules will force hospitals and doctors to give a 30-day guarantee for any hospital treatment. If the patient is readmitted within 30 days for the same ailment, Medicare won’t pay the hospital. Here are a few things you, the patient, need to know now about these changes:

Why the change?

Because of the ineffective discharge processes described above, many patients may not understand how to take their medications; they may not have the follow-up appointments they need, or their primary care physician may not have been contacted about their hospitalization. All too frequently, the primary care physician does not receive a discharge summary in a timely fashion.

Because of these loose ends, patients too often do not receive the care at home they need, and their illness worsens. With no one to turn to, these patients all too frequently end up in the emergency room, where they are readmitted to the hospital. In the past, hospitals made more money because they were able to bill for these repeat hospitalizations, despite the fact that the readmission represented a failure in the discharge planning.

What’s the change?

Beginning in October 2012, Medicare will no longer reward caregivers and hospitals for poor planning.
If a patient is readmitted within 30 days with the same diagnosis, Medicare will no longer pay for the care. Medicare is now expecting health delivery systems to guarantee their care for a minimum of 30 days. This is a far cry from automobile repairs, which are often guaranteed for years, or even for the lifetime of the car.

Why do patients have such low expectations for healthcare? Through this change in policy, Medicare will be creating a major driver for improving discharge planning and hand-offs to those responsible for the long-term care of patients. Fumbles by the acute caregivers will no longer be rewarded. Other insurance companies are likely to follow Medicare’s lead.

How can patients who utilize Medicare to take advantage of these changes?

As a consequence of this new rule, caregivers and patients will need to be on the same team. Physicians and hospitals will be penalized if you do not understand how to take your medications and if you do not understand and follow the plans for follow-up care. If you do not understand what to do when you are discharged, it is important that you speak up and ask questions.

Also, you should insist that your care team provide you with contact information that will allow you to get all your questions answered when you return home. Experience has shown that many patients think they understand their treatment plans, but upon reaching home, they realize they did not fully understand the instructions for taking their medications or what appointments they were supposed to arrange. Many hospitals will be providing a care coordinator to assure that everything goes smoothly after your discharge. This is an ideal solution and will provide you with a go-to person who can help you when the unexpected occurs.

Do these new rules apply to readmissions related to a byproduct or side effect of a treatment?

If the side effect should have been anticipated or could have been prevented, the answer is yes. Too often, patients are discharged on too high a dose of a drug or, alternatively, are prescribed two medicines that interfere with each other. I am unclear what position Medicare will take when there is an unexpected side effect that could not have been predicted or prevented.

Healthcare is undergoing a major and necessary transformation. And we all should be prepared for more change. Keep a close eye on news reports and articles like this one to stay up-to-date and knowledgeable about your health care. These changes represent a move in the right direction, and hopefully, our health system will continue to move forward. Changes like the 30-day readmission rule promise to benefit every patient. By focusing on what is best for patients, Medicare promises to continue to motivate all caregivers and hospitals to improve the quality of their care.

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