AAFP, AOA, AAP, and ACP have all endorsed the medical home model. These are practice patterns they've been asking for financial support to implement in primary care for several years.
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Of course.. because the IDEA of making patients better.. and able to be at home makes sense. The problem is in the implementation of it.
Heck.. when you talk in generalities.. it makes sense to have hospitals be reimbursed better if they can keep their patients home and not have to be readmitted. On the surface that's a great idea. The hospitals provide better care in the hospital.. more aggressive therapies, more coordinated care.. do better discharge planning.. and reduce their length of stays and get patients home in better condition...
Wow.. sounds awesome.
the problem is in the practice. The assumption here is that hospitals that were screwing up before.. that were part of the problem.. suddenly slapped their hands on their foreheads and said "well crap".. "lets start treating these patients better. Lets start spending more money on discharge planners, lets spend more on therapist times and evaluations, lets spend more money on pharmacists, etc.. to provide better and more coordinated care. "
What has happened is that hospitals have NOT improved their care.. but instead are controlling the patient flow downstream to manipulate their reimbursement.
Home health agencies submit data directly to CMS on functional status and independence/dependence scores. They have to report it when they receive a patient, every 60 days from then on, and at discharge. That's part of OASIS, it's been in place for years. And it'll play a significant role in the home health value-based purchasing program.
that's right. And out of curiousity.. are Home Healths finding that the complexity of patients has GONE DOWN?
And please show me on the Oasis.. where the potential of the patient is detailed and whether they met that potential or not.
Now.. go to SNF.. and their MDS.
Are SNF"s finding out that their patient case loads are becoming less complex?
And again.. show me where the potential of the patient is recorded and whether they met that potential on discharge.
And honestly.. whats worse about this is that in twenty years of being a medical provider.. I have seen the expectations for these patients begin to drop since 1998.
We know more of how to make them better, more functional.. but over time the reimbursement paradigm is not to help them reach full potential.. but to get them to the cheapest care possible as fast as possible (even though in the long run is much more costly.. way way way.. more costly).
A hospital purposefully sending home sicker patients and patients unready for discharge will incur higher readmissions, even if that patient ends up going elsewhere. Doesn't matter under the readmissions reduction program if the patient shows up in a different hospital, the readmission counts against the hospital that discharged him. So any hospital doing what you're describing will lose money in the long run for poor quality performance. As it should.
Well it won't... and that's because the pressure that it puts on the home healths and SNF's and assistive livings to NOT transfer these patients OR to not transfer them to the hospital.. overall will artificially improve their reimbursements. ..
The SNF's and Home Healths are transferring these patients when they feel that HAVE to.. to other hospitals in an attempt to avoid the wrath of the original hospital... not to help that hospital financially.
We love to pass the buck in this country.. and we are doing it right now.
these patients that are going home.. sicker. and less functional? Eventually are going to need a lot more care.. a LOT more care as they age.. then they would have if they had been taken care of properly.
Who knows though.. maybe we will again see the day when its acceptable that Grandma spends her "golden years".. in a bed. A wonderful hospital bed.. an expensive pressure relieving bed to be sure. With a home health aid to get her something to drink at a call bell.. in her home.
But still in bed.