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One of the key provisions of the ObamaCarelaw that could result in drastic cuts to hospitals for treating the elderly and the poor will kick in today. In an attempt to rein in the costs of medical care which many critics say will hurt the elderly and the poor the most, the ObamaCare law will now mandate as of Oct. 1, 2012 that patients who need to return to the hospital for follow-up admissions within 30 days of discharge may not get the level of care they have come to expect.

The new provision will place fines on hospitals for treating returning patients who are readmitted within 30 days after discharge. Critics say that this will lead to serious declines in both the level and quality of care rendered to patients.

D4PC Opinion: Obama healthcare machine set to legislate "better outcomes" by imposing financial penalties on hospitals who they determine are having too many hospital readmissions over a specific time period. Of course, government bureaucrats and number crunchers fail to recognize factors beyond hospital/physician control such as patient non-compliance with medications, diet, follow up and other disease modifying behavior.

"A provision of ObamaCare is set to punish roughly two-thirds of U.S. hospitals evaluated by Medicare starting this fall over high readmission rates, according to an analysis by Kaiser Health News".

"Starting in October, Medicare will reduce reimbursements to hospitals with high 30-day readmission rates -- which refers to patients who return within a month -- by as much as 1 percent. The maximum penalty increases to 2 percent the following year and 3 percent in 2014".

"Among patients with heart failure, hospitals that have higher readmission rates actually have lower mortality rates," said Sunil Kripalani, MD, a professor with Vanderbilt University Medical Center who studies hospital readmissions. "So, which would we rather have -- a hospital readmission or a death?"

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Although a focus on readmissions may have good face validity, we believe that policymakers' emphasis on 30-day readmissions is misguided, for three reasons. First, the metric itself is problematic: only a small proportion of readmissions at 30 days after initial discharge are probably preventable, and much of what drives hospital readmission rates are patient- and community-level factors that are well outside the hospital's control. Furthermore, it is unclear whether readmissions always reflect poor quality: high readmission rates can be the result of low mortality rates or good access to hospital care. Second, although improving discharge planning and care coordination is a laudable goal, there are better, more targeted policies that are more likely to be effective in achieving it. Finally, because hospitals are expending so much energy on reducing readmissions, they have probably forgone quality-improvement efforts related to more urgent issues, such as patient safety. An evidence-based, holistic approach to quality improvement is far more likely to achieve what policymakers, clinicians, and the public all want: better care at lower cost.