A reader poses a question: Can I as a physician sue a patient who is non-compliant as his non-compliant actions leads to readmission within 30 days time and again? The simple answer to the question is anyone can sue anyone for any reason. Whether you will win the lawsuit or not is another question entirely. I don't think you would win. I don't even think a basis for your lawsuit exists. I presume you pose the question as it relates to the 30 day readmission rules that are about to stop paying hospitals for the care they provide on patients readmitted within the 30 days for a principle discharge diagnosis of heart failure, acute myocardial infarction or pneumonia. I'm not sure suing patients is going to reduce the readmission rate.
All hospitals and physicians have options. If we don't want to play by the rules being established by the Medicare National Bank, we all have the option of opting out of this program. If we don't like the rules, we don't have to play by the rules. If you find yourself dependent on Medicare money, either you play by the rules or you work hard to find alternative revenue streams and get out. Medicare is undergoing a major change. The program is not sustainable by any reasonable yardstick. Our elected political leaders are forcing all the changes onto the backs of hospitals and doctors under the erroneous assumption that we are to blame for hospital readmissions. All the noise about increasing quality is just that, noise.
The reason we can't afford to provide the care we are promising these days is because we have brainwashed the public and our government officials into believing we can provide more care than we actually can. A great part of what we do in chronic disease management offers no longterm therapeutic value. We provide short term bridges to the next hospital readmission. Medicare has graciously defined what our goal should be. Our treatment bridge is now 30 days. Why? Because that's the economic reality they have defined for us.
As doctors, we help navigate a chronic disease out of the acute phase. However, we cannot make a failed liver work again. We cannot make end stage COPD patients breath normal again. We cannot make a nearly dead heart beat again. Beyond the diagnostic portion of our medial practice, successful management of chronic disease is much less a medical issue than it is a social issue. If we want to prevent hospital readmissions, we have to reengineer our society, not punish our hospitals and doctors. It's just easier to blame hospitals and doctors than to blame all the rules and regulations won by special interest groups that got us here.
The simple and easy fix is to stop paying hospitals. The only people who are going to suffer when their inner city hospital closes due to a lose of millions of dollars in funding are the medically complicated poor inner city patients. You could almost consider the no payment rules for hospital readmissions policy racially biased.
Hospital profit margins are already in the negative. That's not going to stop patients from being noncompliant. It won't make them take their medications. It won't make them go to their doctor visits. It won't make them better understand the limits of what we can do for them. In fact, it might even make access to care more difficult. It won't give them transportation to get to their doctors' visits. It won't make them stop drinking or smoking or eating fast food. Nope. When we stop paying hospitals for readmissions, we will simply reduce their ability to provide care to these poor folks.
Even though we live in the age of technology, biology will always win. Call it God's Victory if you will. In the era of shock television where glorified technology can fix everything and unmanaged patient expectations rule the day, our patients are staying alive longer, often under miserable circumstances, because we can make it happen. When Medicare finally implodes, and it will, things are going to get really ugly. How quickly that happens depends entirely on how quickly we are able to get control of our spending crises in this country.
Readmissions are going to be a part of life for the hospitalist. In fact, as a hospitalist, I know many of my patients are readmitted multiple times in a year. That's because biology always wins. For whatever reason, CMS has chosen 30 days as the magic number to avoid payment for services provided. Hospitals will do everything in their power to get patients to this thirty day window. And then stop. Hospitals simply don't have the resources to reengineer society. Their goal is to get paid. There is no medical basis to the 30 day window. This is a cost containment program. It isn't about quality or value based purchasing or accountable care organizations or whatever the message of the day is. It's about not paying for care provided. Would these people survive in a country that did not have the promise of unlimited access to all health care all the time. Not a chance.
If we want to avoid readmissions, putting the burden on hospitals to make it happen doesn't make sense. Hospitals and physicians are in the business of treating disease. Treating disease is expensive, especially given the enormous regulatory burdens we practice in. We know that 5% of our population spends 50% of our health care dollars. Hospitals will formulate programs to keep their frequent fliers out of the wards for thirty days. These folks will then get readmitted on day 31 and it isn't going to save CMS a dime. It will just make hospitals that fail to play the game correctly shut down even faster and it's only going to get worse.
If Medicare wants to save money, CMS has to admit that hospitals and doctors are not to blame. We have two generations of failed social engineering policies sponsored by special interests and imposed on us by a Congress that only looks to the next election for answers. If we want to reduce readmissions (past the magic 30 day window), we have to reduce chronic disease. This process will take decades and a complete reengineering of society. Or, we could try suing our patients and see how far that gets us.
