The government is capping reimbursement rates for specific diagnoses and having hospitals pay to fix their own medical errors, including hospital-acquired infections. The plan is to lower inefficiencies, thereby lowering costs. "We want hospitals to do things more efficiently," says Dr. Ross Koppel, professor of sociology and affiliate professor of medicine at the University of Pennsylvania. "We don't want to redo tests or subject people to hideous radiation because exam records have been lost, for example. There may be some inefficient practices that were money makers, but with a more efficient system hospitals can't get away with them."
Hospitals with excessive numbers of readmissions for Medicare patients will face large penalties, and hospitals that serve the poor will be particularly vulnerable.
Still, hospitals are not responsible for a significant amount of the recidivism they see, according to research published in 2011 by the University of Toronto, which revealed that only a quarter of hospital readmissions were preventable.
"Hospitals have very little control over what patients do when they leave the hospital, so in that case there is an unfairness in penalizing hospitals," Koppel says. "The hospitals may do a good job and tell patients what to do when they get home, but then the patient goes back to drinking, smoking and eating cupcakes all day."
Sheil said hospitals will be getting paid less and still have to do more. "Nobody is immune to that, not even Cleveland Clinic," she says.
The news appeared to be particularly devastating to a hospital system that President Barack Obama applauded only four years before for delivering exceptional care at costs well below the national norm. Still, Cleveland Clinic officials were attributing its most-recent cuts to a number of factors, and pointed out that it was continuously developing ways to be more efficient. "There are many factors, and any one isn't going to tip us over," Sheil says.
"We're not blaming health care reform. We think it is very necessary," she adds. "Something had to give because costs are going to continue to rise and it's unsustainable."
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