Accountable Care – a new wellness partner

On October 1st Medicare started to penalize hospitals for patients who are readmitted into the hospital within 30 days of discharge for the same diagnosis. This is initially designed to curb the percentage of Medicare patients who are routinely readmitted for three primary conditions; heart failure (24.7%), heart attack (19.7%) and pneumonia (18.5%). The healthcare industry is tracking all diagnosis readmissions, and bracing for other diagnosis to be added to the penalty list.

There’s no doubt serious issues will arise within this new accountable care environment, one being that some hospitals are choosing not to officially “admit” Medicare patients, instead classifying them as “under observation”. Unfortunately, to the patient there is no clear indication they are just under observation, and many older adults have found themselves with large bills for post-acute rehabilitation stays because since they were never officially admitted to the hospital they are not eligible to receive Medicare reimbursement for rehab services. Be aware and ask for clarification of the satus of any hospital stay.

On the positive side, this is quite simply the biggest boost to the business case for prevention and wellness promotion that I’ve seen in the 20+ years I’ve been in the field of older adult wellness. For the past 5 years I’ve been advocating for senior living to take a leading role in changing the way people view and experience aging. And this is a golden invitation for senior living to become the champions of recovery, re-claiming vitality after a health crisis, and reframing possibilities – regardless of challenges. All the pieces and parts are there – it’s just a matter of claiming that “space” in the healthcare continuum. 

One response to “Accountable Care – a new wellness partner”

  1. Halleluiah Kay! Right on! I know several case managers who work in hospitals and they say – “ah, the penalties are so low, many hospitals don’t pay attention to them” but I suppose that will all change starting this year… right? I wonder, according to your statement, “hospitals won’t officially admit medicare patients” geez, they’re becoming like physicians, turning medicare patients away.

    I love that you are an advocate of changing negative perceptions about aging. The older I get the more I want to eliminate them from my thinking too.

    Thank you and right on!

    Carol

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