An examination of Medicare cost and quality issues

Chronic conditions and readmission to the ER trigger significant costs to the hospital system and Medicare while efforts are underway to save Medicare money by preventing hospital infections and falls.

USA Today reports on the cost of hospital readmission, as part of a collection of articles: "A recent New England Journal of Medicine study reported that on average, almost one in five Medicare beneficiaries who are discharged from a hospital will re-enter it within a month. Some are planned, but the majority are not." 

USA Today report looks at readmission at the University of Virginia Medical Center and interviews surgeon Jeff Young, chief quality officer and the director of UVA's trauma center. "At UVA, the 30-day readmission rate is around 5%, which adds up to about 1,300 patients out of 26,000 annual admissions. ... Young says unplanned readmissions often come back through hospital emergency departments, and research suggests such hospital visits drain billions from the health care system annually. But many hospitals are working on turning that statistic around, Young adds. And the issue has garnered attention from the Obama administration, which has proposed health care reform that would include lowering readmissions" (Marcus and Bello, 9/8).

In a second article, USA Today reports on the cost of chronic conditions: "Nearly half of Americans have a chronic condition, and 75% of the $2.6 trillion spent annually on health care goes to treat patients with long-term health problems, says Kenneth Thorpe, a professor at Atlanta's Emory University and head of the Partnership to Fight Chronic Disease." In addition, ninety-five percent of Medicare spending is linked to a chronic disease, according to the article.

USA Today also looks at the role that the shortage of primary care doctors plays in the problem and how health care reform proposals would address that issue: "A bill in the House of Representatives would improve payment for primary-care doctors who see Medicare and Medicaid patients, raising Medicaid rates even more significantly so that they equal those in Medicare. Other proposals in Congress would establish a pilot program to test more "medical home" models . . . and fund a study on ways to balance the supply of specialists and primary-care providers" (Szabo, 9/8).

The Wall Street Journal reports: "The government won't save much from Medicare's year-old policy of refusing to pay hospitals' extra costs to treat hospital-acquired infections and injuries such as bedsores, a new study concludes. Medicare adopted the policy last year with the goal of saving lives and cutting costs. Each year, about 1.7 million Americans acquire infections while in the hospital, and 99,000 of them die, according to the federal Centers for Disease Control and Prevention. Medicare . . . stopped paying the extra costs of treating 10 hospital injuries and infections beginning Oct. 1, 2008" (Zhang, 9/9).

NPR reports on efforts to prevent falls: "Patient falls are the most common injuries reported in hospitals. Many hospitals are making simple changes. For example, patients aren't given diuretics before bedtime, as a full bladder might tempt patients to make a nighttime bathroom trip by themselves — a classic scenario for a fall. ... All this patient protection isn't just happening out of benevolence. In some states, hospitals now have to publicly report their fall rates. There is also a financial incentive: Medicare will no longer pay for costs related to certain hospital falls. Those falls can add more than $4,000 in excess charges per hospitalization" (Pfeiffer, 9/8).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.