'Frequent fliers' cost health system billions

The idea is an intriguing one, but one that is fraught with problems - how does one factor in issues of patient noncompliance? or account for the poor medical care (as opposed to physical/occupational therapy) provided in many SNFs. Unless one can upgrade both the number of nurses in SNFs and their skill levels to prevent, detect and remedy a patient's deteriorating status and make physicians more available to treat patient problems promptly, it would be unfair to penalize hospitals.In this managed care environment, hospitals are literally forced to discharge patients who are medically fragile and marginaly unstable. Unless the next level of care (SNF) is equipped to pick up where the hospital leaves off, the patient will either die or be readmitted. As a nurse, I have personally witnessed this happen to several relatives and friends - and have had to demand that a relative be transferred back to the hospital from an SNF because the SNF was unwilling or there was lack of proper medical oversight. With the level of illness of many SNF patients the time has come for SNFs to have "hospitalist" type of physicians on staff 24/7.

How can readmissions cost the government an additional $12 to $15 billion when hospitals do not receive payment from medicare for readmissions within 30 days?

The so-called data are ridiculous, based upon biased opinion- the institue for health care improvement to justify its own existence and the federal government's ineptitude about the effects of age and disease on hospital and medical care utilization rates. I work as a hospitalist. I know thew reasons for re-admissions. Causes of re-admission are: poor home health care and nursing home payments and poor payments to doctors for patient care at home and in nursing homes. Those with multi-system disease near the end-of-life refuse to enter hospice programs because of the "free" care provided my Medicare. Doctors - especially specialists - cannot afford to lose patients to a hospice program - there are too many medical and surgical specialists in the nation. The data from the Dartmouth (Medical School) Atlas have the data which proves my points - too many doctors leads to care of dubious benefit at best. Since doctors and hospitals will not bite the bullet and give patients the real data about treatments, their side effects and poorer outcomes that occur when patients are above the average longevity age then you can be sure the government will provide the incentives - lower pay, more scrutiny and publication of the names of non-performers - to do so.

My sociopathic step-father has learned how to "play the game" for a few days of R&R and meals on trays delivered bedside as he watches t.v. He frequently goes to the ER, lies about vague symptoms and manages to get admitted for a few days of xrays and other non-painful tests.