Information on ACA Hospital Discharges and Readmissions

The Affordable Care Act changed the law regarding hospital readmission policies, and therefore the way you are discharged after your hospital visit. Before these laws were enacted, a typical hospital visit might have looked like this: Today is the day your surgery is scheduled. You arrive at the hospital at the agreed time, get all the paperwork and paperwork done, get settled in your room, are wheeled into your operating room, and a few hours later, the nurse says, “Once you have a bowel movement, we’ll send You go home.”

Never mind that you now have a slotted hole in your midsection (along your legs, across your shoulders, etc.). Your pain level is going through the roof and you feel like you’ve been hit by a semi truck. You can’t imagine them wanting to send you home so soon.

There are many reasons why a hospital may want you to leave as soon as possible after surgery. They are similar to why they want to be discharged quickly, whatever the reason for their admission. That said, at some point, they no longer make enough money for them to spend their time keeping you.

Why the hospital wants you to be discharged

Here are some reasons why they want to fire you ASAP:

  • Insurance and Medicare have guidelines on how much they are willing to pay for each diagnosis and treatment plan (called an ICD) that you may be admitted to the hospital. Once you pass that deadline, the hospital may no longer reimburse you for your stay, and unless something else goes wrong, they can bill and get reimbursed.
  • If you are a Medicare patient and are at any risk of infection, either from surgery or because you have compromised immunity to infection, the hospital wants you to leave before the infection starts to appear. This is because if you develop a preventable illness (called a never-occurring event, or a serious reportable event) during your hospital stay that is the hospital’s fault, Medicare will not reimburse the hospital for Care that must be provided to you while you are in hospital. Squat. So, logically, the sooner you get out of the hospital, the less likely you are to have any infection, or a preventable event while you’re still there.

The second reason also illustrates the Law of Unintended Consequences or Newton’s Law of Motion in Healthcare. When hospitals were warned in 2010 that they would start losing reimbursement if their patients made preventable mistakes, they started discharging patients far earlier than many were prepared.

Consequences of early discharge

What happens next is: patients go home, or are discharged to a nursing home or rehab, only to discover that there are major issues with their ability to heal, including finding out they are infected, or not getting the proper guidance or where-with-all to manage them recovery. So they would go back to the hospital for readmission, in which case the hospital could make money off of them again, because the problems with their admission didn’t arise until after their first discharge. Going back to the hospital is good for the patient, it can be reimbursed, and it is also good for the hospital. (Don’t mind the extra stress and slow healing caused by moving the patient from here to there and back again on her first discharge.)

It didn’t take long for Medicare to figure out what hospitals were doing and how much the system would cost. So, as part of the Affordable Care Act (ObamaCare, also known as the ACA), another new regulation was included. That is, if the hospital readmitted a Medicare patient within 30 days of discharge, it would be penalized through a lower reimbursement amount. In 2012, more than 2,000 hospitals were penalized.

What to Expect from ACA’s Hospital Readmission Policy

If you are hospitalized, you may see some changes, some good and some problematic.

First, you’ll start seeing higher levels of more effective communication from hospital staff knowing you’ll be formally judging them through patient satisfaction surveys, and you’ll also start seeing more effective discharge planning. You may be given a lot of reading material, you may be asked to watch videos on how to take care of yourself after you leave the hospital, and you may even get a call to check on you after you go home (or in rehab). These are all attempts at good customer service that will definitely work in your favor.

However, we may also start to see some other unintended consequences play out across the system. A new (and easily considered unethical) way of making more money was discovered in mid-2012 when it was discovered that if hospitals treated patients, even for days or weeks, even without They can also make more money by acknowledging their situation. In particular, Medicare patients are kept on “unpaid observation,” which, for many, means they will have to pay for medical care out of pocket.

The goal of regulating how hospitals reimburse patients is to eliminate overcharging and fraud, which is key to the ACA’s success. Ensuring that these regulations do not cause additional problems for patients will require smart patients to come forward when they see the resulting problems.

Can you fight discharge?

Yes, of course you can. If you or a loved one realizes it would be wiser for you to stay in the hospital, you can appeal the decision to let you go.