[Alex]

Originally Posted by scaeagles

I enjoyed this piece by a Duke University professor named John David Lewis. One may not agree with his conclusions, but he sure lays out a lot of very valid concerns in a very logical way.

Well, he's certainly better at citing his issues. But the first one starts with a great big deception so I'm not hopeful the quality is going to be much better than the other list.

First, he completely fails to mention that the section he is concerned about has absolutely nothing to do with the new Health Care Exchange programs being established in the bill or new regulations required of private health insurance. The section he is quoting is an alteration to existing Medicare (really, why do I keep wanting to spell it Medicair?) coverage.

Second, while the section does indeed seek to create incentives for avoiding unnecessary hospital readmissions, the goal is not to deny coverage but to improve patient outcomes (here's an article explaining the idea behind it). Essentially, the idea is that it encourages the hospital to get it right the first time.

Finally, the first section he quoted says pretty much exactly the opposite of what he is suggesting it says:

(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.

That is not saying that certain readmissions will be barred. It is saying that for procedures and conditions where there does not exist a sufficient history for evaluating what would be excessive, such readmissions will not be counted towards the total.

Fourth, this does not result in rationing of care. A hospital accepting Medicare patients will still have to take them for as many readmissions as are needed, but if they are seeing returns at a level way beyond stastical norms the hospital may not be paid as much.

That said, after such a horrible start with his first item a quick glance through the rest and things appear a bit more reasonable and generally highlights legitimate issues appropriate as points of policy discussion. Though he does continue the trend of ignoring things that are already done and thus implying that they're somehow new.