Did you know that
- being admitted to the hospital is an undesirable thing, and if it can be avoided, it should be?
- if you have to be admitted, being readmitted for the same thing is not good?
- avoiding readmission saves money?
- better home care after admission helps to prevent readmission?
- the web site to compare hospital performance, including readmission rates, was launched under Republican HHS Mike Leavitt?
Sure, you know these things. Everyone knows at least some of these things. Except if your name is Bill Kristol. Kristol doesn't know any of these things.
Even while quality centers like Baylor are being lauded for decreasing readmission rates (lower is better, because it is quality care and because it saves billions in unnecessary health care dollars and, by the way, because the patient in question is healthier and suffers less), Kristol, writing in the Weekly Standard, thinks readmission is wonderful and desirable, and anything that interferes with your God-given right to scrimp on outpatient care after discharge (because that's how you avoid readmission) must be some Communist plot to steal your precious bodily fluids. Basing his latest brand of ignorance on a Ted Kennedy article in Newsweek, Kristol writes:
But the most important implication of the Kennedy-Shrum claim--"Most of these readmissions are unnecessary, but we don't reward hospitals and doctors for preventing them. By changing that, we'll save billions of dollars."--is this: The government is going to decide--ahead of time, obviously, since deciding after the fact wouldn't save any money; and based on certain general criteria, since the government isn't going to review each individual case--what kinds of hospital readmissions for the elderly are "unnecessary" and what kinds aren't. And it's going to set up a system "to reward hospitals and doctors for preventing" the unnecessary ones. That is, the government will reward hospitals and doctors for denying care they now provide, care the government will now deem "unnecessary."
Yes, Bill, it's already happening and doesn't depend on new reform. These standards already exist and can be found at HospitalCompare. As a matter of fact the National Quality Measures Clearinghouse™,
sponsored by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, is a public repository for evidence-based quality measures and measure sets.
For decades health professionals have known that health reform consists of three areas:
and the idea of looking at outcomes-based data to improve care quality is hardly revolutionary.
Under current rules, readmissions can be denied. Doctors try to avoid them. Here's a professional's take on the eality of the current system:
In the case of Mr. D, the hospitalists might end up getting a denial—and suffering a loss of revenue—for a readmission that had nothing to do with them. Hospitalists are seldom cognizant of such repercussions because we are programmed to perform patient care without contemplating the financial implications.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) collects data for their core measures program. A part of this effort also involves reporting the readmission rate within 14 days—both for the same diagnosis and for a different one.
But you knew that. You knew that preventing unnecessary readmissions was a good thing, and that many people and entities (including doctors, hospitals and insurance companies as well as regulatory agencies and governments) already work to avoid them. You also know that denial of care by insurance companies includes readmissions, and is hardly a new concept. That's because your name isn't William Kristol.
The "strategist" (and I use the term very loosely) that brought us Sarah Palin and the Iraq War is an embarrasment to pundits everywhere, and continues his tradition of ignorance with health reform. It begs the question of how frequently and spectacularly you have to be wrong before people stop paying you for your opinion (after being fired from the Times, he got a gig at the Post. Fox doesn't have standards, so I will skip that discussion.)
Conservatives sorely miss Bill Buckley. There don't seem to be any intellectual grown-ups left without him.