Medicare shouldn't be surprised by readmission rate it helped to create

LETTER — Posted May 31, 2010

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Regarding "Quality experts hope health reform delivers substantial improvements in care" (Article, April 19): I read your article with great interest. When I got to the section on readdressing readmissions, I began to think that I had entered the Twilight Zone.

Medicare constantly ratchets down the length of stay for diagnosis-related groups. Officials expect patients to be discharged after fewer and fewer in-hospital days. They also are then surprised and unhappy when those patients are readmitted.

I have spent many years serving on utilization review committees for various hospitals. In my opinion, 90% of readmissions are either because the patient has the kind of illness (e.g., end-stage COPD) that is going to require increased readmissions because of the nature of the illness, especially if the patient does not wish hospice care, or because a patient is being rushed to discharge to fit an ever-decreasing length of stay for that DRG.

For Medicare to constrict the amount of time permitted in the hospital and at the same time be shocked and appalled at increasing readmissions is ludicrous in my opinion.

David S. Gans, MD, Arcata, Calif.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2010/05/31/edlt0531.htm.

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