Medicare Takes Aim at Boomerang Hospitalizations of Nursing Community Residents

Federal records indicate one in five Medicare beneficiaries sent from the hospital to a nursing community come back within 30 days, often for potentially preventable conditions, reports Kaiser Health News . These rehospitalizations occur 27 percent more often than for the Medicare population at large. "There's this saying in nursing communities, and it's really unfortunate: 'When in doubt, ship them out,'" says Harvard Medical School Professor David Grabowski. "It's a short-run, cost-minimizing strategy, but it ends up costing the system and the individual a lot more." Beginning in October, the government will offer nursing communities bonuses or penalties based on their Medicare rehospitalization rates. Congress' Medicare Payment Advisory Commission estimates that the rate of potentially avoidable rehospitalizations declined to 10.8 percent in 2016 from 12.4 percent in 2011. "There's still a high rate of inappropriate readmissions," Grabowski notes. Medicare remunerates hospitals a set rate to care for someone depending on the average time it takes to treat them with a given diagnosis. That means that hospitals profit by earlier exit and lose money by keeping people longer, even though seniors may need a few extra days. Still, nursing communities have to hospitalize residents, since keeping them out of hospitals requires regular examinations and speedy laboratory tests, which add costs. Moreover, most residents are covered by Medicaid, which is typically the lowest-paying insurance plan.