Betsy McCaughey: For seniors, an Obamacare gimmick costly in cash and healthBY BETSY McCAUGHEY
May 19. 2014 8:05PM
On May 7, the Obama administration boasted that Obamacare was improving health-care quality for seniors, and it pulled out a bag of statistical tricks to prove it. But a closer look shows that it’s not improving care. It’s skimping on it, socking seniors with unexpected bills for “observation care” and likely shortening their lives.
President Obama’s Health and Human Services department announced that fewer seniors discharged from the hospital are returning for additional care within a month’s time. HHS claims that this drop in “readmissions,” from 18.5 percent in 2012 to 17.5 percent in 2013, signals quality improvement.
Nonsense. The 50 best hospitals according to U.S. News & World Report’s Best Hospitals annual rankings have above-average readmission rates.
Nationwide, readmissions are dropping because Section 3025 of Obamacare punishes hospitals if a senior returns within 30 days.
What happens to the senior treated for a heart attack who rushes to the hospital a week later feeling faint, possibly because of arrhythmia?
To dodge the penalty, hospitals put the patient under “observation.” It’s just a word on the chart. The patient may get the same tests and be put in the same room as if he had been admitted. But unless he stays at least two nights, the hospital won’t bill Medicare for a stay, and the patient gets clobbered with the cost.
So much for HHS boasting about the drop in readmissions. HHS officials fail to mention that this coincides with a rise in elderly patients placed under “observation status.”
Penalizing readmissions, which started in 2013, is one of the law’s tricks to reduce Medicare spending, never mind the impact on seniors. Cuts in future Medicare spending pay for more than half the law’s cost — robbing Grandma to fund health-care coverage for other groups.
It’s true that some readmissions are unnecessary and can be avoided if patients follow up with their doctors and take their meds after leaving the hospital. Low-income patients are less likely to do that, and hospitals caring for the poor are getting whacked hardest by Obamacare’s readmission penalty.
The Obama administration plans to expand the readmissions penalties in 2015 to apply to many more conditions. It’s no wonder medical experts are protesting. Dr. Ashish Jha, a professor at the Harvard School of Public Health, says it’s bogus to equate declining readmissions with quality. Many top academic hospitals have high readmission rates because their patients have serious illnesses and complications needing repeated stays.
Jha says the gold standard for measuring a hospital’s quality is how many patients survive a specific disease. Dr. Bruce Lytie, chairman of the Cleveland Clinic’s heart and vascular programs, also warns not to trust claims that lowering admissions improves quality.
Don’t trust Obamacare’s definition of “value” either. Obamacare defines it in a way that produces the opposite: dangerously skimpy care for seniors. Section 3001 sets up a bonus system to reward hospitals for “value.” Bravo for rewarding hospitals that prevent infections. But the lion’s share of bonus points go to hospitals that spend the least per senior. That cost-cutting will shorten lives.
Evidence from 208 California hospitals shows that Medicare patients treated in the lowest-spending hospitals had a worse chance of surviving their illness and going home than patients with the same diagnosis treated at higher-spending hospitals. The research, sponsored by the National Institute on Aging and RAND, found that heart-attack patients were 19 percent more likely to die at low-spending hospitals. Who would want those odds? Over a four-year period, 13,613 seniors who died from pneumonia, stroke, heart attacks and other common conditions at California’s low-spending hospitals might have recovered and gone home had they been treated elsewhere.
Ignoring this evidence, Obamacare incentivizes hospitals in all 50 states to imitate lowest-spending hospitals that are deadly for seniors. That’s some definition of value.
Betsy McCaughey is former lieutenant governor of New York and author of Beating Obamacare: 2014. Her website is www.BetsyMcCaughey.com.