Medicare Readmission Penalties Could Cause Premature Death, Doctors' Survey Shows

TUCSON, Ariz., Oct. 25, 2012 (GLOBE NEWSWIRE) -- The Association of American Physicians and Surgeons (AAPS) released the results of an on-line survey on the potential effect of Medicare's refusing to pay if patients are readmitted after hospital discharge.

Of 527 respondents, 87 or about 17% said they had "first-hand knowledge of patients who were placed on 'terminal sedation' with denial of fluids and nutrition in US hospitals, when in your opinion they might recover with aggressive treatment."

Only 10% of respondents (53) thought that such reports were not credible, and 85% (458) thought that "Medicare's punishment for readmissions could result in premature demise."

AAPS sent the survey to members and supporters, according to executive director Jane M. Orient, M.D., because of a report from a member. This senior physician, an internist, has the old-fashioned practice of visiting her patients when they are admitted to the hospital. She found one patient, who had been independent and vibrant a few weeks before, to be near death although hospitalized for a treatable illness. After her private physician took over her care from the hospital-employed hospitalist, the patient recovered to her former state of health.

"We wanted to see whether this was an isolated instance of treating an elderly but basically healthy person, whose usual status was unknown to the hospitalist, as if she had terminal cancer," states Dr. Orient.

Medicare has recently adopted the policy of penalizing hospitals by nonpayment if patients are readmitted with heart failure, heart attack, or pneumonia. More than 2,000 hospitals have incurred more than $280 million in penalties. The most heavily penalized hospitals have the lowest mortality rates, according to the September issue of AAPS News.

Some fear that U.S. hospitals may implement the "Liverpool Care Pathway" of denying fluids and nutrition, which is reportedly used in 29% of patients who die in British Hospitals, as reported in June 19 issue of the Mail Online.

"Death before readmission is our hospital's goal now," commented one respondent. "No Death Panels needed."

Medicare's stated goal may be to improve discharge planning and out-patient treatment, but "some readmissions are unavoidable," observed one physician.

Complete survey results and comments are available from AAPS.

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, which was founded in 1943 to defend the sanctity of the patient-physician relationship.


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