To help rein in escalating Medicaid costs, several states are severely restricting hospital stays. However, that move has been stirring up some opposition, especially from former CMS Administrator Dr. Donald Berwick, who deemed such caps on care "nonsensical" in a recent interview with Kaiser Health News.
"The amount of care that a Medicare beneficiary should get should be the amount of care they need. Otherwise, isn't that rationing?" he told KHN, adding that establishing an arbitrary limit on hospital stays doesn't make any sense.
If a patient needs 20 days in a hospital, he or she should get 20 days, he said. But that logic may not hold up for Medicaid recipients in Hawaii, who will be limited to only 10 hospital stays a year starting April 2012, as FierceHealthcare previously reported.
Berwick expressed concern over the lack of accountability and transparency in the way Medicare, Medicaid, and private insurers decide what (and what not) to cover.
"I think an informed public ought to want to know what they can get, what they cannot get, and who is making that decision, so that those people can be accountable for those decisions," he said.
While keeping healthcare costs in check is important as the industry shifts to patient-centered and accountable care, hospitals may end up footing the bill for patients for days not covered by Medicaid under new state limits.
Rationing Medicare and Medicaid care may not be the answer to delivering high-quality, cost-effective care. According to Berwick, those programs aren't broken; the overall healthcare delivery system needs fixing.
"We set up a delivery system which is fragmented, unsafe, not sufficiently patient-centered, full of waste, unreliable," he told KHN.
With his exit from the administrator post at CMS, he said the question remains: "Are we going to get that fast enough?"
To learn more:
- read the KHN interview transcript