Why Medicare Reform Means Maintaining Low Cost, Readmissions
By - Medicare reform must boldly empower seniors to better control their healthcare spending, according to an October report from Devon M. Herrick, PhD, Senior Fellow at the National Center for Policy Analysis. Herrick presents a tri-fold Medicare reform approach to a variety of challenges within the current healthcare landscape.
Hospital readmissions among Medicare beneficiaries are perhaps becoming more routine than rare. One in five seniors discharged from a hospital is readmitted within 30 days, says Herrick, with over a third of Medicare hospital discharges readmitted within 90 days. At least half of discharged seniors will return to a hospital within a year’s time, maintains Herrick.
Chronic conditions may be to blame. Fourteen percent of beneficiaries utilizing traditional, fee-for-service (FFS) Medicare have at least six chronic conditions, says Herrick. One-third alone have two or three. Chronic conditions are increasing in number along with the likelihood of hospital admittance and Medicare spending, notes Herrick. A beneficiary with multiple chronic conditions is more likely to end up inside of the emergency room, and be later readmitted, he says.
Herrick poses a solution to such data. “Medicare should use medical homes, care coordination, and utilization management that reward plans for boosting quality and lowering costs, especially among chronically-ill beneficiaries,” says Herrick. “A well-managed physician network is the key to coordinating care, increasing quality and controlling costs,” he adds.
Herrick estimates 75 percent of Medicare readmissions are avoidable with proper transition care. Nearly 5 percent of patients spend half of all healthcare dollars, Herrick states, with the sickest 1 percent exhausting almost a quarter of total healthcare expenditures. Therefore, by focusing care on only the sickest 5 percent, healthcare costs will tangibly drop, says Herrick.
Echoing such statements, as RevCycleIntelligence.com reported, it is perhaps more imperative than ever to focus on the causes of hospital readmissions – such as mental health issues related to anxiety – to prevent readmissions from occurring. For instance, a hip fall that occurs more than once may have happened because an individual too depressed to properly clean his or her home fell amidst clutter. In the wake of numerous school shootings and the like, such a focus may strengthen the health – and subsequently wealth – of the nation.
Nonetheless, Herrick says empty hospital beds keep costs down. “To be effective, efforts to slow the growth in Medicare spending will have to focus on reducing hospital spending on beneficiaries in poor health by better managing their chronic conditions,” he states. “Increasingly, controlling costs means keeping people out of hospitals, where nearly one-third of health care spending occurs.”
Effectively implemented Medicare reforms are indeed imperative when it comes to matters of money. In 1970, Medicare spending per beneficiary fell below $400 annually, notes Herrick. Current figures top $12,000. As RevCycleIntelligence.com stated in reference to an earlier report on Medicare reform from Herrick, Medicare per capita spending may hit $19,000 within the next decade.
Health systems waste money in several tangible ways, maintains Herrick, such as care being inappropriately administered within a hospital setting when a patient may have been better off receiving the same care from the comfort of his or her own bed at home.
Says Herrick, “[A problem] with having many different silos of care – each with different attending physicians – is that care coordination among providers is often neglected to the detriment of the patient. Coordinated care not only creates opportunities to improve treatment outcomes, if done properly it also saves money.” Managed care transitions that are not strongly managed “are very costly,” he adds, often leading to a patient being readmitted to a hospital mere days after his or her discharge. Exclaims Herrick, “And it’s a serious problem!”
A top solution, says Herrick, lies in improved quality care transitions. “A care coordinator at a patient-centered Medical Home could steer seniors to lower-cost health care settings, evaluate the need for home care and ensure seniors receive post-hospital follow up care and comply with drug therapy instructions,” he maintains.
It is hopeful a long-lasting trend will emerge where Medicare beneficiaries can stay outside of hospital walls and worry about the simple joys of life instead of a hearty stack of avoidable medical bills.
