Question

According to the provisions of the Affordable Care Act, hospital reimbursement for healthcare services can be severely limited or entirely eliminated in paying for patients readmitted to the hospital within 30 days of discharge for conditions such as pneumonia. This well-intended provision was put forward with the goal of getting healthcare organizations to provide sufficient post-discharge support to patients. However, this provision is resulting in lack of reimbursement for purposeful re-admissions that occur within 30 days. For example, Jane was admitted to the hospital with pneumonia. During her hospitalization, a chest x-ray revealed a large mass in her left lung. She was stabilized and discharged from the hospital a couple days later with plans to readmit to the hospital for a biopsy of this mass within 3 weeks of the discharge. How would situations like this adversely impact the hospital for just doing the right thing by providing excellent care and follow up to Jane's problem? Provide a suggestion to fix this problem.

Answer 1

As per the Affordable Care Act the provision to reimbirse the readmission within 30 days of hospital admission was restricted or may be eliminated completely. This provision was passed for making the care more governed and appropriate and enabling the individual achieve high quality care without any not needed admissions within 30 days. It was seen that the use of these coverages was being misused by some of the organization as the source of mintting profit. Therefore. This clause was added to prevent any such unspecific admissions.

But due to this provision some cases that require genuine and well framed readadmission for the patient within 30 days of first admission are suffering. As in given case the client was required to be admitted for biopsy within 3 weeks and the provision makes it difficult to claim coverage during this admission. In such cases this law is making health care challenging rather than better for the individual.

To resolve this issue i suggest that the external audit members should be appointed. These specialized members should have ability to identify the need for readmission to be genuine and part of the appropriate care and allow the cases such as Jane to achieve reimbursements and restrict the reimbursement for other cases that is seem to be duw to medical negligence and inappropriate post discharge care.