Private insurance companies as well as Medicare and Medicaid do not like to pay for re-admission and if re-admission is necessary for non-emergency situations these insurance providers do penalize the hospital and possibly the doctor. Studies have proven that a high proportion of hospital re-admissions are high preventable. To this end, there are strong financial incentives for hospitals to shorten hospital stays and to keep patients from being re-admitted. This does help create a system of checks and balances and ensures that hospitals do keep medical care for patients while in the hospital at high levels.
Insurance companies and Medicare/Medicaid are continually looking for ways to reform hospital reimbursements to reduce re-admissions, improve quality and reduce medical errors or healthcare acquired conditions. It is an ongoing goal to stop infections that are exclusive to hospital care such as some types of staph or MRSA infections, and errors in surgeries. Re-admission rates are governed by the Affordable Care Act which includes Medicare Shared Savings Programs, hospital value- based purchasing, and demonstration of bundled payments. Unfortunately there are still high statistics for re-admission by disabled non-elderly Medicare patients, the elderly and pregnant women or maternal patients who are on Medicaid.
Re-Admission Statistics
In the past several years, 30-day re-admission statistics were reported as 25 percent greater between disabled, non-elderly Medicare patients than between Medicare patients that were sixty-five and older. This statistic includes those patients who are re-admitted with the same malady or problem in a 7, 14 or 30-day period. It is also an alarming statistic that non-maternal Medicaid/Medicare patients who are between 45 to 65 years of age are re-admitted 60 percent more than uninsured patients and more than 50 percent more than privately insured patients. This may indicate that reforms in Medicare/Medicaid policies need to be considered. Maternal, or patients who have been admitted for one inpatient stay related to pregnancy, childbirth or post-partum conditions in a year, re-admitted patients are 50 percent higher for the uninsured. Pediatric patients are often re-hospitalized or readmitted within 7 to 14 days at a 50 percent rate.
As a summary, Medicaid patients are re-admitted within a 30 day period about 1.6 times more than privately insured patients. Statistics show that non-obstetric adults who have anemia are re-admitted at 14.4 percent if insured with Medicaid compared to 9.4 percent for those who hold private insurance. For patients with diabetes or chronic diseases 12.6 percent are re-admitted, those who are substance abusers are re-admitted at a 12.3 percent rate, and patients with mental problems are generally re-admitted at 11.9 percent. These statistics may not sound too high, but when you consider that re-admissions for private insurance holders are in the 8 percent range; these are alarming statistics. To be more alarmed, remember that tax-payers are responsible for the funds that go into the Medicaid/Medicare system.
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