Tuesday, April 24, 2012

Obamanation:  Penalizing Hospitals Financially for 30-Day Readmissions: The Downside

1.       The country we live in, can be both good and bad; 2) the country where Obama is president; 3) patently false and outrageous claims about President Barack Obama

 Definitions of Obamanation

April 24, 2012 -  To hear some critics tell it ,  Obamanation  is a play on the word “Abomination ,” which, in turn,  is often a condemnation of Obamacarenation and its unrealistic provisions.  

In the April 12 New England Journal of Medicine,  two sets of authors  (1,2)explain what is wrong with a provision in the Affordable Care Act that penalizes hospitals for “worse than expected” readmissions that occur within 30 days after discharge.  The penalties  are designed to help the government make up for the $17 billion it spends on the nearly 20% of readmissions that occur the 1st month after discharge.

Unfortunately, as pointed out in the 2 NEJM articles, these readmissions are largely beyond the hospitals’ control and have little to do with hospital quality. 

As authors of one article say,

“ Evidence suggests the primary drivers of variability in 30-day readmissions are the composition of a hospital’s patient population and the resources of the local community – factors that are difficult for hospitals to change.”

Readmissions, in their words, are more about mental illness, poor  social support, and poverty, not  quality of hospital care. Hospital admission rates largely affect institutions care for a poor or minority population with a high burden of mental illness – precisely the populations that Obamacare was designed to protect.

Hospitals with low mortality rates for myocardial infarction,  chronic heart failure, and pneumonia – the three conditions for which penalties will be exacted – have higher readmission rates because they keep the sickest patients alive, and these are the patients likely to be readmitted.   

High readmission rates have little to do with supposed villains – hospital-acquired  infections, premature discharges, and poor communication between patients, hospital personnel , physicians, caregivers, community-based clinicians, and poor planning.  Studies indicate less than 20% of readmissions are “preventable.” Paying these penalties  often distracts and drains funds from hospitals’ other quality and safety-directed efforts.

Oh, well, as Samuel Johnson,  the 17th century dictionary-maker and social critic, observed, “The road to hell is paved with good intentions.”

Tweet: The Affordable Care Act, aka Obamacare, is destined to fail if it hopes to recoup the loss of $17 billion spent on hospital readmissions.


1.Robert Berenson, et al,”Medicare’s Readmission-Reduction Program – A Positive Alternative,” NEJM,  April 12, 2012.

2.  Karen  Joynt, et al, ”Thirty-Day Readmissions – Truth and Consequences, “  NEJM, April 12, 2012.


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