by James C. Sherlock
Sometimes you have to laugh to keep from crying.
The Guardian, a UK-based tabloid with a U.S. edition, wrote a thunderous exposé about UnitedHealth. The title: Revealed: UnitedHealth secretly paid nursing homes to reduce hospital transfers.
First paragraph:
UnitedHealth Group, the nation’s largest healthcare conglomerate, has secretly paid nursing homes thousands in bonuses to help slash hospital transfers for ailing residents – part of a series of cost-cutting tactics that has saved the company millions, but at times risked residents’ health, a Guardian investigation has found.
The details of United Health’s alleged activities were well reported and gut wrenching. UNH stock, already weak, cratered.
But the story entirely missed the larger context.
Readers of that article, and perhaps its author, are left ignorant of the fact that Medicare and Medicaid do the same thing — pay for lower re-hospitalizations — for the same reason that UnitedHealth does. Money.
Payers. Centers for Medicare and Medicaid Services (CMS) uses multiple measures to reward or penalize nursing homes in its value-based purchasing system. One is Skilled Nursing Facility Within-Stay Potentially Preventable Readmission (SNF WS PPR) Measure. Section 2.2 Purpose/Rationale for the Measure focused on cost savings.
Hospital readmissions among the Medicare population are common, costly, and often preventable. The Medicare Payment Advisory Commission (MedPAC) and a study by Jencks et al. estimated that 17-20 percent of Medicare beneficiaries discharged from the hospital were readmitted within 30 days. Among these hospital readmissions, MedPAC has estimated that 76 percent were considered potentially avoidable and associated with $12 billion in Medicare expenditures.
Medicare and Medicaid offer bonuses and levy financial penalties on hospitals and nursing homes for their performances in that measure and several others.
Medicare, Medicaid and UnitedHealth all claim to be motivated to improve patient care. OK. Maybe.
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