Jim’s Take

Understanding Health Care Stories

Bias is inherent in all reporting – after all, reporters are people, and they interpret what they see through the jaundice of their own viewpoint.

I’m not talking about blatant “fake news” of the kind practiced by political reporters on both sides of the liberal/conservative spectrum … I’m talking about looking at a set of facts and interpreting them based on your own inherent set of beliefs.

I recently ran across two articles published on the same day.  One was titled, “Cheaper home healthcare causes higher readmission rates, study says.”  The other was titled, “Home health saves Medicare money despite higher readmissions.”

What amused me is that BOTH came from the same article in JAMA. And both are “right” — there ARE more re-admissions from home health care than from Skilled Nursing Facilities.

It was a study of 17,230,000 Medicare post-hospital outcomes when patients were sent to either a Skilled Nursing Facility (SNF) or Home Health Care.  That’s a BIG study.

Those sent for home health care facility were 5.6% more likely to be readmitted.  So the first article’s headline (the only thing the majority of readers are likely to actually read) is correct.

But the second article reported that “Despite that, the authors noted home health saved Medicare $4,514 on average in the 60 days after the first hospital admission because their services cost marginally less than SNFs.”   So the second article was ALSO correct in its headline.

The real culprit – surprise, surprise – was a Medicare regulation that pays hospitals less if their readmission rate was higher than it should be.  So hospitals clearly prefer to send patients to SNFs to minimize the readmissions.

In so doing, they cost Medicare money.  So the same Medicare regulation designed to lower costs ended up costing more.  Bureaucracies the world over are all the same.

Interestingly, neither mortality rates nor functional status rates don’t differ much whether the patient was treated at home or in skilled nursing, so that seems to me to suggest three things:

  • The less expensive treatment method is just as good as the more expensive, and
  • Hospitals are referring to locations that help their overall reimbursement rates, NOT to the locations that are most worthwhile to either the payer or the patient, and
  • Reporters and editors choose their headlines based on their own preconceived world view.

One of the articles gave — what to me is — the most cogent conclusion of all:

[Dr. Rachel] Werner [chief author of the study] said there is an opportunity to change how home health is reimbursed to lower the vulnerability for readmissions. Right now, Medicare only pays for one home health visit per day, so the agencies are limited in the extent of services they can provide. If CMS were to expand the number of home health visits it pays for daily, home health agencies could provide more comprehensive services to patients and prevent readmissions.

In other words, the chief author of the study thinks it’s possible to have your cake AND eat it, too.  Or maybe that’s just my world view.

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