In October 2012, a part of the Affordable Care Act went into effect in an effort to reduce
Medicare spending. This act limits hospitals on how often they can accept patients for re-
admittance for a chronic problem. For instance, if a person has heart surgery and comes back
a second time for complications, the hospital faces a one percent fine.
Consider this example. Bill is released from the hospital after having heart surgery. He comes
back one week later with complications and is sent home. He then returns to the hospital a
few days later with the same symptoms. The hospital sees him and then submits the claim to
Medicare. If the bill is $100,000, the hospital has to pay the one percent fine, which reduces
the reimbursement to $99,000.
This plan is expected to cut Medicare costs by $290 million in the next year. And, it’s not just
limited to Medicare. Many Medicaid plans are doing the same thing by limiting the number
of hospital visits that patients can take. Additional hospital visits with the same diagnosis
within a 30-day period will be denied by Medicaid. These new plans are a desperate attempt
to reduce federal spending, but is there a silver lining?
Hospitals tend to treat lower-income patients who don’t have resources to primary care
doctors and pharmacies. Limiting their access to health care can be unfair, and it wrongly
punishes hospitals. However, the good that can come of this is that hospitals need to do
a better job at keeping people healthy when they do get home. This includes giving them
detailed and accurate information about follow-up treatment.
If you have an elder at home who is chronically ill, the Affordable Care Act is something to
consider. With stricter requirements on hospital visits, you may find that respite care is your
best option. Respite care will help your loved one get the support they need to keep them
out of the hospital and following their care plan. With different programs available, it’s easy
to choose a plan that fits your family’s needs and budget. After all, getting care while it’s
needed is better than being turned away in a moment of desperation.