The NY Times reports: Hospitals in New York State are significantly worse than those elsewhere in the nation at limiting patients from having to return shortly after being treated for a major illness, according to federal data released on Thursday.
The new data come amid a national debate over how to reduce the rate of hospital readmissions, which cost the federal government billions of dollars a year in Medicare reimbursements.
The stakes are high for hospitals: Congress and the Obama administration are considering financial penalties for hospitals with high rates of readmissions and incentives for those with low rates.
Critics of hospitals with high readmission rates have long accused the institutions of having a financial motive for creating what they call a revolving door for patients. Generally, hospitals are paid for each admission, regardless of how long the patient stays in the hospital. So when patients return, the hospital is paid again for the new treatment.
The data drew fierce criticism on Thursday from some New York hospitals, which said that the government was not giving them credit for treating poor and uneducated patients who may return because they do not have access to primary-care nurses and physicians and so are regular users of the emergency room.
But a number of health care experts pointed out that some hospitals that treat poor patients, like Harlem Hospital Center, a city-run institution, managed to do well on readmissions, while others, like Montefiore Medical Center, a large academic institution in the Bronx, did not, suggesting that there was more to the equation than demographics.
Across the country, about one in five Medicare patients end up back in the hospital within 30 days after being discharged, according to a recent article in The New England Journal of Medicine.
An analysis published in The Journal in April estimated that unplanned hospital readmissions accounted for $17.4 billion of the $102.6 billion that Medicare paid to hospitals in 2004. It found that half of the nonsurgical patients readmitted within a month had not seen a doctor for follow-up care after they were discharged.
The new data were posted on Medicare’s Hospital Compare Web site. The information looks at how many Medicare patients had to be readmitted to hospitals within a month of being discharged after treatment for heart attack, heart failure or pneumonia between July 2005 and June 2008.
In all three categories, New York hospitals, when measured against the national rate, fared poorly.
Dr. Gary Kalkut, senior vice president and chief medical officer of Montefiore Medical Center, said on Thursday that the data failed to recognize the disparity between how affluent and poorer patients care for themselves after discharge.
“There are people we discharge who don’t have a primary-care doctor,” he said. In contrast, he said, hospitals with more affluent patients could rely on them to take care of their own health.
Peter Ashkenaz, a spokesman for Medicare, said that the data were adjusted based on medical risk factors that often correlate with socioeconomic status. But he added in an e-mail message on Thursday, “Hospitals are expected to meet the needs of their patient populations and provide a high level of health care services without regard to the diverse socioeconomic characteristics of the patients.”
Readmission rates were mixed among the city’s 11 public hospitals. But Ana Marengo, a spokeswoman for the city’s Health and Hospitals Corporation, credited the good results at some city hospitals to practices like connecting patients to home health services, providing a month’s supply of medicine when patients are discharged and having translation services available.
N.Y.U. Langone Medical Center and NewYork-Presbyterian Hospital, which serve many affluent patients, along with some less affluent ones, had readmissions rates on a par with the national rate.
Dr. Robert Press, chief medical officer at N.Y.U., credited measures like a partnership with the Visiting Nurse Service of New York and giving written discharge instructions to patients.
(Source: NY Times)
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One Response
forget all the statistical mumbo-jumbe, designed to confuse you.
The fact is that the basic paradigm on which today’s allopathic medical system is based is defective at its core.
This kind of hi-tech, drug-centered medicine is obsolete and ineffective in 85% of the cases entering the hospitals.
We need to break the stranglehold of the trillion-dollar drug companies and start using all the natural non-drug therapies that have been proven successful all over the world, at a mere fraction of the cost.