By Tomer Gofer, CEO & Co-founder, Vaica
Caraline Watkins, Contributor
Medicare is confusing for a lot of reasons. People aren’t quite sure what they can claim for under medicare, some are still having to use a medicare mbi converter after the recent change from HICNs, and those who use medicare are having issues with the services being provided. Today, we are going to be focussing on an issue that is especially relevant to us – problems with nursing home visits.
A recently published article by the Washington Post discussed the growing problem with Medicare patients and nursing home visits. It sheds a light on the lack of communication between doctors and the nursing homes, and focuses on the situation of patients who fall through the cracks and need specialized care. 1 in every 5 patients return to the nursing home within 30 days after they are discharged and the re-hospitalization rate for Medicare patients is 27% higher than the average. The article also mentions that the percentage of readmission rates that could have been avoided dropped from 12.4% in 2011 to 10.8% in 2016, so, there is progress being made, but there is still a long way to go. How can this problem be addressed in a patient centered approach? Maybe we should consider not moving these patients back and forth between different hospitals and facilities, but caring for them at home. This solution could focus on individualized care that helps patients get healthier with the least amount of complications (such as missed medication intakes, changes in doses, and lack of care continuity) in the comfort of their home and with the support of their families.
Medicare laws currently are set up in a way that the facility gets paid by the amount of days averaged out to the certain disease state or admission reason. Then, when the patient is discharged early, the facility benefits with more pay per day and less days actually taking care of the patient. But is this really helping since the patient will most likely return due to the lack of care? This law is being revisited this fall and with new Medicare laws, the government want to introduce rewards and penalties based on admission and readmission rates.
For example, the article mentions a patient who was not properly taking her thyroid medication due to lack of communication with the doctor and nurses at the nursing home. By not taking her thyroid medication she suffered greatly and it was eventually her family that discovered the error. Another example of misconduct due to lack of communication is when a patient was being administered too much of a blood thinner from a lack of communication between the nurses that resulted in more hospital visits and eventually death.
There is also the issue of the lack of staff at nursing homes and care facilities. The lack in staffing can cause a multitude of problems ranging from patients not getting the individual care that they need, not receiving their proper medications, and protocols falling in the cracks.
Taking these patients in and out of the hospital and nursing homes is not providing them a place to recover physically and mentally. These patients need a place where they feel safe and cared for so they can fully recover back to their full health, whether that be with West PACE or another local group.. By having an at-home care service, these patients will not only get individualized care that they need, they could have a support net that is proven to be most beneficial, and true care continuity which is most important. Maybe we need to take a step back, and look at how we can better serve the patient instead of glorifying laws and pursuing paybacks.