Postel Mackenzie, Frank Paul N, Barry Tod, Satou Nancy, Shemin Richard, Benharash Peyman
Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Am Surg. 2014 Oct;80(10):1003-6.
In accordance with the Affordable Care Act, Medicare has instituted financial penalties for hospitals with 30-day readmission rates that exceed a predetermined value. Currently, this value only considers "excess" readmissions for myocardial infarction, heart failure, and pneumonia with a maximum fine being one per cent of total Medicare reimbursements. In 2015, this penalty will increase to three per cent and encompass more surgical diagnoses. We retrospectively reviewed a database of adult patients undergoing cardiac surgery treated at our institution in 2012 to establish whether patients with readmissions within 30 days of the index operation could have been managed more cost-effectively without readmission. A calculation of cost efficiency was performed to compare the net hospital profit for two scenarios: admitting patients versus hypothetical preventative measures. Of the 576 patients during the study period, a total of 68 (11.8%) patients with unplanned 30-day readmissions were identified. Outpatient management was determined to have been feasible for 18 (26.5%) patients. Whereas the calculated net profit for readmission was $144,000, inclusion of Medicare's penalty resulted in a loss of $11,950. A readmission reduction program with an annual cost exceeding $11,950 would lead to financial loss. The financial implications of Medicare's readmission penalty alone necessitate the development of cost-effective strategies to reduce rehospitalization.
根据《平价医疗法案》，医疗保险已对30天再入院率超过预定值的医院实施经济处罚。目前，该预定值仅考虑心肌梗死、心力衰竭和肺炎的“超额”再入院情况，最高罚款为医疗保险总报销额的1%。到2015年，这一罚款将增至3%，并涵盖更多外科诊断。我们回顾性分析了2012年在我院接受心脏手术的成年患者数据库，以确定初次手术后30天内再入院的患者是否可以通过避免再入院而得到更具成本效益的治疗。我们进行了成本效益计算，以比较两种情况的医院净利润：收治患者与假设的预防措施。在研究期间的576例患者中，共识别出68例（11.8%）计划外30天再入院患者。确定对18例（26.5%）患者进行门诊治疗是可行的。再入院的计算净利润为14.4万美元，而计入医疗保险罚款后则亏损11950美元。一项年度成本超过11950美元的再入院减少计划将导致财务损失。仅医疗保险再入院罚款的财务影响就有必要制定具有成本效益的策略以减少再次住院。
