William Katz:  Urgent Agenda

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WHO WANTS THOSE MESSY CASES? – AT 8:03 A.M. ET:  Especially in the enlightened age of Obamacare.  As Americans learn more and more about the provisions of this law, they'll be more and more horrified.  Sarah Palin's ridiculed charge that Obamacare will involve "death panels" seems rather on the mark. 

The patient – decked out in non-skid footies, a loose hospital gown and a breathing tube – prays she’s finally on the mend. At age 81, Juanita King had logged nearly five weeks at WakeMed Hospital since October after her breathing became so labored she had trouble walking.

The Clayton grandmother, weakened by a failing heart and obstructed lungs, wasn’t home even two weeks after the first hospital stay before returning to WakeMed earlier this month for another round of needles, meds and tests.

WakeMed, along with hospitals across the country, is scrambling to keep patients like King from coming back. Under federal penalties that kicked in Oct. 1 as part of the Patient Protection and Affordable Care Act, hospitals lose Medicare reimbursements if their patients are readmitted at an excessive rate.

WakeMed officials, for example, estimate that the 15 readmissions since 2010 that Medicare deemed excessive will cost the Raleigh health care company more than $400,000 in the coming year.

Reducing excessive readmissions is a perfectly laudable goal, if it can be handled in accordance with high medical standards.  But can it?  Some hospitals might do it well.  But, as we have painfully seen in examples from the British system, some will clearly not.

...industry advocates warn of a potential downside: Struggling hospitals, spooked by the prospect of huge penalties, could develop an unhealthy fixation on finding ways not to readmit patients who need hospital care.

Already hospitals nationwide have seen an uptick in patients being steered to observation beds rather than getting admitted, Foster said. Hospitals in economically distressed areas with limited health care options are most likely to readmit patients and pay penalties for doing so, she said.

“It’s hard to think there will be a financial penalty against your organization to do the right thing by your patient.” Foster said. “We don’t think that hospitals that serve impoverished, safety-net communities should be penalized because those communities lack the necessary resources.”

COMMENT:  What's wrong here is that guidelines will be established centrally, in Washington, as the left moves relentlessly toward its dream – socialized medicine.  This is a large, diverse country, and medical practices in one area might have a certain irrelevance for patients in another.

I once compared notes with a writer friend of mine from a heartland mid-sized city.  We are about the same age.  We found that the death rates in our high-school graduating classes were dramatically different.  About a third of his fellow graduates were deceased.  In my class it was about eight percent.  His school area was plagued by automobile accidents, alcohol abuse, and gunshot cases.  Mine was not.  His area would clearly call for a different emphasis on certain kinds of health care.

I fear we're heading for a one-size-fits-all medical system.  Might work in Sweden, with a population a bit larger than that of New York City.  It can't work here.

November 26, 2012