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A motion blurred photograph of a patient on stretcher or gurney being pushed at speed through a hospital corridor by doctors & nurses to an emergency room.
This might be one more sign that Republicans are easing their repeal-and-repeal-only stance on Obamacare—four senators including two Republicans—are working on an Obamacare fix to help safety-net hospitals. Granted, Sens. Roger Wicker (R-MS) and Mark Kirk (R-IL) aren't really among the firebrands among Republicans, and they're working with Joe Manchin (D-WV) and Bill Nelson (D-FL) who aren't the vanguard of the left, but it's still progress.

Here's the problem they're addressing: The law penalizes hospitals for readmitting patients within a month of their discharge. That's done in an effort to reduce errors in hospitals that require the follow-up admission, and ultimately to save money. The problem this creates is a greater burden on the hospitals that serve low-income populations.

Medicare does have some ways of adjusting penalties to take into account the sickness (or health) of a hospital's patients. But there are still things happening outside the hospital—a lack of primary care providers, for example, or difficulty following discharge instructions—that can send lower-income patients back for a second visit.

As a result, safety net hospitals are about twice as likely to get slammed with big readmissions fines compared to other providers. Medicare is asking safety-net hospitals to work much harder—then penalizes them when they don't perform as well as everyone else.

The legislation these senators are offering would require that Medicare consider the socioeconomic status of patients at these hospitals when they review their performance and dole out penalties, essentially giving safety-net hospitals a break. That's the kind of thing that some bipartisan cooperation might have taken care of in the law when it was written, but better late than never, I guess.

It's going to provide a good test case for where Republicans are at nowadays with Obamcare, something they haven't seemed to be able to work out for themselves. The law has a lot of support outside of Congress, "endorsed by the American Medical Association, the American Hospital Association, and a bevy of other provider groups." Senate Democratic leadership should put this one on the fast track, to put their Republican colleagues on the spot.

Originally posted to Joan McCarter on Fri Jun 20, 2014 at 09:20 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (34+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Fri Jun 20, 2014 at 09:20:53 AM PDT

  •  That's Mitch McTurtle lifts up his (0+ / 0-)

    REALLY BIG hammer.

  •  excellent test signal to force GOP messaging (4+ / 0-)
    Recommended by:
    skillet, Chas 981, jasan, FloridaSNMOM
    It's going to provide a good test case for where Republicans are at nowadays with Obamcare, something they haven't seemed to be able to work out for themselves. The law has a lot of support outside of Congress, "endorsed by the American Medical Association, the American Hospital Association, and a bevy of other provider groups." Senate Democratic leadership should put this one on the fast-track, to put their Republican colleagues on the spot.

    Warning - some snark may be above‽ (-9.50; -7.03)‽ eState4Column5©2013 "If we appear to seek the unattainable, then let it be known that we do so to avoid the unimaginable." (@eState4Column5)

    by annieli on Fri Jun 20, 2014 at 09:27:30 AM PDT

  •  Is This Bill Revenue Neutral? (0+ / 0-)

    If not, it won't pass the House of Representatives.

  •  How long until... (2+ / 0-)
    Recommended by:
    jasan, FloridaSNMOM

    This amendment is killed and those same Republicans start whining about how Obamacare penalizes hospitals serving poor communities and must be repealed?

    "Believe nothing, no matter where you read it or who has said it, even if I have said it, unless it agrees with your own reason and your own common sense."

    by grape crush on Fri Jun 20, 2014 at 09:55:01 AM PDT

  •  Bets on how many Republicans (1+ / 0-)
    Recommended by:

    vote for cloture?

    Over/Under is currently 2 (the co-sponsors).  Dems need 5.

  •  Good idea if (1+ / 0-)
    Recommended by:

    they can get it passed, but in addition to socio-economic status it should also address the patient's ICD-9 code.

  •  Wow. I am amazed that Wicker (1+ / 0-)
    Recommended by:

    has a hand in this.  Simply amazed.

    •  He knows there's no risk involved (2+ / 0-)
      Recommended by:
      NinetyWt, MichaelNY

      McConnell will "go slow" on it even if it gets to the floor without too much scarring from the committee process. And if/when it eventually gets past the filibuster, Wicker knows Boehner will just stumble up to his podium and drone on about repeal-uhhhhhh, I mean, "starting over."

      "If you're going to go down with the ship, make it a submarine." - Wayne Shorter

      by Oliver Tiger on Sat Jun 21, 2014 at 07:22:34 PM PDT

      [ Parent ]

  •  I worry that the TP senators will try to load s... (7+ / 0-)

    I worry that the TP senators will try to load something like this down with poison pill amendments if it hits the floor, more than getting enough Republicans for cloture.

  •  As a matter of policy (0+ / 0-)

    it appears highly subjective which can be a bad deal for administrators who have to take the bullets; nevertheless, it appears well intended enough at face value.

    Surprised you'd ask though where Republicans stand on the ACA - They're fucked.

  •  When done to teachers no one blinks an eye (6+ / 0-)

    Logic and research matters when its a hospital but when its a all the teachers, throw out tenure.
    And good democrats are all on board.
    But a hospital serving a disadvantaged population, wow, logic kicks in and changes are made that attempt to address the real problem, i.e., lack of resources, literacy, etc.
    But a school?
    Must be the teachers fault and fire them all.

  •  I hope this goes through (2+ / 0-)
    Recommended by:
    mchristi314, OleHippieChick

    Many people who are on Medicare are only a heartbeat away from being on Medicaid.. regardless of their political bent.. regardless of how bulletproof they feel..

    The big answer is single payer.

    A step in the right direction would be closing the Medicaid gap that SCOTUS created and that my state of Florida jumped all over with frat-boy joy.

    If you don't like it, attack the message, not the messenger. The former may convince me that I am wrong, but the latter will always convince that I am right.

    by nancyjones on Sat Jun 21, 2014 at 08:18:59 PM PDT

  •  Let's hear it for something positive being done... (0+ / 0-) both sides for a huge change.

  •  It would be better... (1+ / 0-)
    Recommended by:

    I would be better to end the hospital readmission penalty altogether. Besides the issues noted above, I fear that it may perversely lead to worse care for those who need it. People who need the care should be re admitted if they need to be without any concern about that re admission penalty.whatever the intention of this stupid provision, I think it will ultimately lead to poorer healthcare and possibly at greater cost.

  •  I'm going to go out on a limb and say: (1+ / 0-)
    Recommended by:

    Boehner, king of the Oompa Stumpas doesn't let this come up for a vote in the House. I also, too, predict the sun will rise tomorrow, around dawn.

    I ride the wild horse .

    by BelgianBastard on Sat Jun 21, 2014 at 09:19:48 PM PDT

  •  too early releases? (1+ / 0-)
    Recommended by:

    I think I'm missing something. . .
    Doesn't the penalty help prevent releasing patients before they are really ready to go home?

    •  Not necessarily (1+ / 0-)
      Recommended by:

      If someone can't afford their medications they'll come back with the same problem or worse. There are also people who have fallen through the cracks and still have no insurance or can't qualify for Medicaid. Those people may have to go home with family instead of going to a long term care or rehab facility and get readmitted for a variety of reasons.

  •  And for an unintended consequence..... (3+ / 0-)

    One of the things we are seeing in California hospitals is that patients are being kept on "observation" status longer than before - this means they are not actually admitted and if they aren't admitted they can't be re-admitted.  This can have complicated consequences for the patient in terms of what is covered or not, how well they are covered for the hospital stay, or their eligibility for a convalescent care admission afterwards.  The driver is the effort to avoid the re-admission penalty.  This is only one of a number of ways that the hospitals' and insurers' efforts to game the ACA are having negative consequences for patients.  Not what was planned, but that's the way it's working out.

    "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verité et de la dire" Jean Jaures

    by Chico David RN on Sat Jun 21, 2014 at 09:23:43 PM PDT

  •  Hospitals are the bad guy, here. (1+ / 0-)
    Recommended by:

    Hospitals are suffering because ObamaCare successfully shuts down their biggest racket. Hospitals charge more for non-paying patient ER visits.  Way more.  Then hospitals write off those unpaid inflated expenses against inflated executive salaries.  Then the hospital states that they must increases the costs of all other patients to mitigate the nonpaying patient costs.  Obamacare prevents all that because now everyone's insured.  The next mandate should require hospitals to show purchase price versus billed price on all expendible items.  A catheter should be $15.  Not $150.    Cost in versus cost out.  In addition, another mandate should force hospitals to charge patients a room rate based on occupancy availability.  We'll pay back  these despicable profiteers, and it's going to be delicious.

  •  As a former administrator at a safety net hospital (1+ / 0-)
    Recommended by:

    I can say that the only thing they have to do is restore the disproportionate share add-on that was removed when ACA was considered and then passed.

    The DSA recognizes that a hospital serving the "medically indigent" encounters patients whose social-econ status affects their health. The DSA is formula driven based on % of Medicaid and self pay (read no-pay) patients treated.

    The theory supporting removal of the DSA asserts that with more individuals covered, thus more paying patients DSA becomes unnecessary. But, red state governments, taking their cue from the Supreme Court, wrecked that theory by refusing expanded Medicaid. Result, no DSA adjustment to rates, less money for safety net hospitals, more hospital closures.

    The readmission policy should remain, components of the ACA provide the tools to make that work.

    •  Which Is Why This Is Bad Legislation (1+ / 0-)
      Recommended by:

      This legislation is intended to let off the hook those states which decided to thumb their noses at the ACA because they were too good.  Most of the states with major uban centers have opted for the ACA, with good reason.  Those that haven't should feel the pain of their stupidity.  All this is intended to do is to bail out the conservatives' poor decision making skills.  Just more right-winger welfare from what I can tell.

      "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

      by PrahaPartizan on Sun Jun 22, 2014 at 07:58:00 AM PDT

      [ Parent ]

      •  No, the legislation did no such thing and in (0+ / 0-)

        fact required all states to expand Medicaid if they wanted to receive any Medicaid funding.  The SCrOTUS struck down that part which is what led to the cluserfuck you see now.  In other words, it was the Supreme Court that let off the hook those states which decided to thumb their noses at the ACA because they were too good.

        You have watched Faux News, now lose 2d10 SAN.

        by Throw The Bums Out on Sun Jun 22, 2014 at 09:03:02 AM PDT

        [ Parent ]

  •  Wicker will be primaried for this (1+ / 0-)
    Recommended by:

    He isn't up for re-election until 2018, but the folks supporting Chris McDaniel won't give him a pass.

  •  a Bandaid on a severed limb (0+ / 0-)

    Let's  review:

    US Healthcare = most expensive on the planet (by 2X-5X that of other industrialized nations)

    US Healthcare = rated worst of all industrialized nations.

    US Healthcare = still bankrupting the country.

    For-Profit Healthcare is immoral. 95% of politicians are immoral and in bed with Big Health.

    End of Lesson.

    No longer Hoping for Change. Now Praying for a Miracle.

    by CitizenOfEarth on Sun Jun 22, 2014 at 04:51:59 AM PDT

  •  What a waste of taxpayer money and time. If they (1+ / 0-)
    Recommended by:

    are serious about doing anything of substance towards getting health care to function better for all in this country, then they should get serious and push for Medicare for all, or Single Payer, or call it whatever you wish.


    Any other attempt of the "stuff" that is coming out of the DC politicians be it bi-partisan or not is just pure, unadulterated BS and a waste of time and energy.  Health care reform, the correct version FOR ALL in this country is going to come at some point in time.  

    Better it be sooner than later for those that are suffering and in need of it now.


    “My soul is from elsewhere, I'm sure of that, and I intend to end up there." - Rumi

    by LamontCranston on Sun Jun 22, 2014 at 07:25:29 AM PDT

  •  Slamming safety net hospitals (1+ / 0-)
    Recommended by:

    That highlighted paragraph which discusses the problems of safety net hospitals has parallels in what happens to public schools and teachers in low income areas. Teachers and admin are required to work twice as hard to reach improbable standards and are held to blame when they don't because the culture of the area and its lack of resources  are not taken into consideration when these standards are set

  •  NOOOOOOOOOOooooo (0+ / 0-)

    The readmissions policy is the ONE thing that is actually working at curbing the cost.

    It's a logical policy, It's a fair policy, and it is working.

    Obviously, effing that up sounds like a job for a bi-partisan congress.

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