Growing Pains
When Medicare was established under the Social Security Act of
1965, it was considered a "gentle giant" by many in the field of
health care. Starting a few years back, however, it has
earned a reputation as being a "ferocious beast". With baby
boomers aging, medicine improving, and people generally living
longer, it's no secret that the Medicare system is spending more
than it is generating from tax revenues. That's why, starting
in 2008, the system began aggressively implementing stricter
policies and enforcing policies that were already in effect.
Cracking Down
The current financial crisis is nearing a breaking point, and
those in the Medicare system are doing everything they can to
reduce waste and inefficiencies in the industry, prevent and
terminate fraud, and improve care in general. The latest
tactic began taking effect just last month. Beginning January
1, 2012, hospitals are now penalized when a patient they discharge
readmits to any hospital within 30 days for the same
diagnosis. This mostly applies to patients with primary
diagnoses of pneumonia, heart attack, or Chronic Heart Failure, but
many experts believe Medicare will eventually include other
diagnoses as well. Initially, their rate will be reduced by
1%, then by 2%, and then 3% over a three year period. This
may not seem like a lot, but for a hospital (or network of
hospitals) whose Medicare revenue is in the millions, or even
billions, this is not something hospital administrators, boards,
and shareholders are taking lightly.
A Happy Ending
While this has sent hospitals and sub-acute rehab facilities
that rely on hospitals into a tailspin, in the long run it should
lead to better health care for you and your loved ones.
Here's what you can expect to see over the next few years:
- Improved Communication: With more and more specialists
involved throughout the continuum of care, improving and
maintaining good communication between providers is key to properly
diagnosing and treating patients.
- More Education: Many patients re-admit to the hospital
because they don't fully understand their conditions and the
symptoms that go along with those conditions. Therefore,
providers will invest more into helping patients and there families
understand and appropriately react to symptoms that often do not
require hospitalization.
- Mergers and Acquisitions: Since hospitals are the ones
taking the hit, they're the ones leading the charge. In order
to increase their control over patient care so they can ensure
quality, they will be buying up physician groups, employing
previously independent doctors, and holding their partners to
higher standards.
- Weeding out the Weak Ones: Doctors, practices, rehab
facilities, and all of the other ancillary companies will need to
be at the top of their games, or they'll be forced to find a new
profession!
So, while it may be tumultuous times -- particularly for those
on the providing end, it should ultimately lead to a leaner, meaner
system for all.
Dan Hofford, Community Relations Coordinator, Wesley Place
Rehab
Chicago Senior Living
Assisted
Living in Chicago