Robert Winner


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Fines for hospitals that re-admit heart attack, heart failure, or pneumonia patients.

Hospitals are scrambling to meet a new federal mandate that requires them to keep discharged patients out of the hospital or face escalating financial penalties.

The Centers for Medicare and Medicaid Services last month began cutting reimbursement for hospitals that re-admit patients within 30 days of the patients leaving the hospital after treatment for a heart attack, heart failure or pneumonia.

The new penalties are part of the Patient Protection and Affordable Care Act.

I am not qualified to make medical statements but see these illnesses as the very type of problems that would require follow up, re-evaluation, and possiable re-admission to resolve post operative problems.

If the hospital is being fined when procedures are necessary then would they become less likely to re-admit and deny best practices.

That hospitals take advantage of iinsurance is recognized but is accepted as a means to pay for all the uninsured and illegals that flood the emergency rooms that they care for free .. again by federal law ... and also caused by federals not enforcing federal immigration law.

This is part of the wellness clause of Obamacare care. I am not sure I want the federal government influencing medical decisions. Isn't that why doctors go to medical schools.

Should the federal government fine hospitals for medical decisions?

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    Nov 30 2012: This seems extremely odd. Could you include a link?
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      Nov 30 2012: Technically the hospital is not being fined. They are just not receiving as much in medicare payments.

      See page 290-297.

      "as of the date of the enactment of this subsection to the additional 4 conditions that have been identified by the Medicare Payment Advisory Commission in its report to Congress in June 2007 and to other conditions and procedures as determined appropriate by the Secretary"

      See page 103-116. Specifically the table on 116. Those were the recommendations.
      Interesting they only started with medical issues and no surgical ones. That will be one heck of a physician fight.
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        Nov 30 2012: When I click, I get no page numbers.

        Is there not a risk in penalizing hospitals for readmitting patients who seem certainly to be at risk?

        Is the idea here that hospitals that hold patients longer on first admission would see a lower proportion need to be readmitted?
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          Nov 30 2012: Don't you just love google? The page numbers are at the top of the page for the ACA. The Medpac report at the bottom of the page after the exec summary.

          IMO medicare used to reimburse 4 days for a pneumonia patient. If you send the patient home in 3 days you get to keep the extra. It kinda worked out because you would have some patients stay 5 days. But patients were being discharged too soon too often in the name of reimbursement. Couple things happened after that including Medicare stating that if the patient was readmitted within 30 days, it was all considered one admission. This is just the next evolution of trying to protect patient from corporate greed.
        • Dec 3 2012: Thanks, Linda

          So in other words the idea is to make hospitals shift towards prevention care: from now on it won't be profitable anymore to discharge a patient before they're out of harms way, because if you have to re-admit that patient within 30 days it'll cost you. And yes, this could backfire when someone gets pneumonia twice within one month, but those cases are very rare and therefore the compromise it worth it (and that's also how it works for most health care budgetting regulations around the world).

          Is anyone else getting tired of Robert Winner's misinformed alarmist topics against anything Obama/democrat?
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          Dec 4 2012: @ John
          I am actually with Robert on this one. The problem is basically the distribution of wealth. Lets say I am able to cut down the cost of an admission by 50K per patient. I am taking 50K away from someone and giving it to someone else.
          That's basically what it amounts to. The thing is, nobody knows who someone else is. The someone they are taking it away from are the caregivers, doctors, nurses. But then what?
          If you think it will go back to the taxpayers, you might have a different think coming.
          All this will play out in the next couple of years. Once all of us are forced to buy health insurance wether we need it or not. Already many employers of minimum wage and below living wage are moving to hire only part time workers to avoid having to pay insurance. How are those low income people going to pay for their own insurance at part time pay?

          This more than anything else will exacerbate the poor/wealthy divide in this country.
        • Dec 6 2012: "Once all of us are forced to buy health insurance wether we need it or not"

          How do you know you don't need it? You could get involved in a car crash tomorrow, you can be diagnosed with cancer tomorrow (33% of Americans are diagnosed with cancer at least once in their lifetime). How do you justify taking expensive health care at old age when you didn't pay into the system when you were young while other people did? The ACA will expand medicaid for the poor and help the lower middle class financially to pay for their insurance.

          "Already many employers of minimum wage and below living wage are moving to hire only part time workers to avoid having to pay insurance."

          The new system is designed to decouple health insurance from employment, as in every other developed nation. This will give employees more freedom and security.
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          Dec 6 2012: @ John
          Did you read the document?

          Every other developed nation has national health. NOBODY uses private insurance as a middle man to keep profits from the transaction. Whose entire system is designed NOT to pay. And who answer to shareholders and not policy holders.
        • Dec 6 2012: @Linda

          Switzerland, Germany and the Netherlands use heavily regulated, but private insurance companies, those are just the ones I know off the top of my head.


          Swiss and Dutch insurers are allowed to make a profit off of supplemental plans (such as dental care), which all of them do. I know for a fact that all German insurers are independent of the government. Belgium is another country that has independent insurance. Incidentally the European countries ranked highest when it comes to healthcare are 1) The Netherlands, 2) Switzerland, 3) Germany and 4) Belgium, they're also among the most expensive systems, but nowhere near as expensive as the American "system" and they cover everyone. With America's culture being as it is, it's natural for the United States to try to emulate one of these four countries instead of the fully government run British, French or Swedish systems. Maybe, in 50 years time history will show the British system works better overall but first things first.
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          Dec 6 2012: All of these are from Wikipedia

          Germany's health care system was 77% government-funded and 23% privately funded as of 2004.

          To compete in the market for compulsory health insurance, a Swiss health insurer must be registered with the Swiss Federal Office of Public Health, which regulates health insurance under the 1994 statute. The insurers were not allowed to earn profits from the mandated benefit package

          The first lesson for the United States is that the new (post-2006) Dutch health insurance model may not control costs. To date, consumer premiums are increasing, and insurance companies report large losses on the basic policies. Second, regulated competition is unlikely to make voters/citizens happy; public satisfaction is not high, and perceived quality is down. Third, consumers may not behave as economic models predict, remaining responsive to price incentives. If regulated competition with individual mandates performs poorly in auspicious circumstances such as the Netherlands, how will this model fare in the United States, where access, quality, and cost challenges are even greater? Might the assumptions of economic theory not apply in the health sector?
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      Nov 30 2012: I searched for ... hospitals to be fined for readmitted patients ... and there are about 10 pages of articles. The original article I wrote from was in the Arizona Republic.

      I found it in the Obamacare document under wellness care and it seemed like it was about 2/3 of the way through so around pages 600 or so.

      If you want to abuse your brain or have nothing to do for a couple of weeks give that document a read. Good luck with that. I did and found some things I really did not want to see.

      When you get to page 107 I will save you some time on dhimmitude .... Dhimmitude is the Muslim system of controlling non-Muslim populations conquered through jihad. Specifically, it is the TAXING of non-Muslims in exchange for tolerating their presence AND as a coercive means of converting conquered remnants to Islam.

      ObamaCare allows the establishment of Dhimmitude and Sharia Muslim diktat in the United States . Muslims are specifically exempted from the government mandate to purchase insurance, and also from the penalty tax for being uninsured. Islam considers insurance to be "gambling", "risk-taking", and "usury" and is thus banned. Muslims are specifically granted exemption based on this.

      The parts on medical care is based on the earning potential is interesting also ... this is the part called death panels by most .. and yes it does exist in the document.

      It is a shame that more people have not read it .... including congress.

      Thanks for the reply. Bob.
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        Dec 1 2012: Oh my gosh I did not realize that is what it meant! I may just have to covert to Islam - lol
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          Dec 1 2012: If the 4th and 5th paragraphs of Mr. Winner's comment are correct I have to say your reaction of levity seems misplaced. Does your apparent knowledge of Obamacare include knowledge about these two paragraphs? (I freely admit I really do not want to read 900 pages of text). Thank you!
          EDIT: I checked both Snopes and Factcheck. They both say exclusion is possible for certain IRS designated sects. Islam does not forbid insurance and is not exempt from penalties for not having medical insurance. They both say the word "dhimmitude" does not appear in the text of Obamacare.
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        Dec 1 2012: @Ed The bill states
        "EXEMPTIONS FROM INDIVIDUAL RESPONSIBILITY REQUIREMENTS.—In the case of an individual who is seeking an exemption certificate under section 1311(d)(4)(H) from any requirement or penalty imposed by section 5000A, the following
        (A) In the case of an individual seeking exemption
        based on the individual’s status as a member of an exempt
        religious sect or division, as a member of a health care
        sharing ministry, as an Indian, or as an individual eligible
        for a hardship exemption, such information as the Secretary shall prescribe. "

        Then it goes on for several pages about the freaking documentation you're gonna need to get out of buying insurance.

        This may apply to certain Muslim sects just as it applies to certain Christian sects like Christian Scientist and Amish. But the restrictions are pretty specific. For instance the church needs to have existed before 1950. Which leaves out Scientology which was founded in 1954.

        But I don't think it applies to the general Muslim religion because many of them access and use healthcare.
  • Dec 1 2012: Can we die because of this? Is it misguided? It could be scary.
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    Nov 30 2012: Read the medpac report I posted to Fritzie first. Based on that data, they better.