A major flaw in the Affordable Care Act is that, while attempting to mitigate the burden of health care spending by spreading it over more people, it did far too little to bring down the overall cost of health care for all Americans.
Far too little. But not nothing. And one of the things the ACA, also known as Obamacare, did do to limit overall health care costs is now being felt at hospitals in Utah and around the nation.
It is an idea that should survive into whatever version of health care we finally come up with. And, contrary to the fears of “rationed care” or ”death panels,” the trick didn’t save money by reducing the quality of care. It is saving money and saving lives.
It’s called a readmission penalty. A provision in the ACA requires that hospitals that get paid by the federal Medicare program — which is roughly all of them — get penalized when too many of the patients treated or operated on in their facilities have to come back within 30 days due to a post-operative infection of some other problem.
The largest such fine known to have been levied for the coming year against a Utah hospital — St. Mark’s Hospital in Salt Lake City — is 2.81 percent of its Medicare payments. That’s up from 1.13 percent in the current year, according to data from researchers at the nonprofit Kaiser Health News. Another local example is the University of Utah Hospitals and Clinics, which will be penalized with a cut in payments of 0.16 percent, compared to 0.42 percent this year.
Not a huge portion of a hospital’s income. But, apparently, enough to get their attention. At least on a national scale, as federal figures indicate that not only are readmission rates slowly falling, but the extra care hospitals are taking to prevent the need for readmission has increased the quality of the care they provide. And, says the Department of Health and Human Services, saved the lives of an estimated 15,000 people.
Spending less on health care is hard. Too many people make too much money from the existing system. Any federal move to really cut those payments significantly would earn the wrath of the doctors, hospitals, pharmaceutical companies and others with the power to stop any bill from passing. Which is why Obamacare doesn’t have as many cost-cutting features as many would like.
And there would always be the fear, justified or not, that cutting spending means throwing away some lives.
But the Obamacare readmission penalties are an example of how the federal government has enough power over the health care market — which it had with Medicaid and Medicare even before there was such a thing as Obamacare — to bend down the curve.
Whatever flavor of health care reform we now come up with must keep that in mind.