Healthcare plays a tremendous role in the U.S. economy. According to the Center for Medicare and Medicaid Services, Americans spent $2.9 trillion dollars in the healthcare industry in 2013, totaling almost $10,000 per person and accounting for roughly 17.4 percent of our nation’s GDP. Because of this prolific spending, legislators are continuously pulled in different directions by organizations vying to protect their respective interests, from multi-billion dollar pharmaceutical companies to tiny non-profit healthcare providers. And, similar to other entities in our free market economy, those invested in healthcare who choose to pursue their economic interests often ignore the social impact of their actions, undermining the realm of common sense and hurting American lives in the process. The entity causing the most damage, though, is not Pfizer, Novardis or Roche; it is the federal government, which has legislated directly against the health of its population time and time again.
I would like to highlight a relatively new program mandated by the Affordable Care Act that rests under the umbrella of counterintuitive legislation, not because it is causing the most damage to our nation’s people, but because it is an occurrence that seems to be rare in the modern state of congressional politics. It is a policy that is non-partisan yet creates a blatant injustice for an entire sector of the population.
Under this provision, which was amended to the Social Security Act and is referred to as the “Readmissions Reductions Program,” hospitals that reach an “excess” of readmitted patients, meaning patients who are admitted within 30 days of their previous discharge, receive a reduction in payment from the CMS. While the amount of patients constituting an “excess” is different for each healthcare institution, the federal government issued a unilateral message in implementing this law: hospitals will be penalized for readmitting the same patients more than once.
The logic behind this program is superficially appealing: with a monetary incentive to reduce readmissions, hospitals and their respective health care providers will act more efficiently and thus be more successful in healing patients on their “first try.” Furthermore, by simultaneously reducing funding to hospitals and supposedly making them more efficient, the federal government will have more money to direct its funds toward other causes, which can appease the political appetites of both Republicans and Democrats.
However, after one digs through all of the “positive” arguments that allowed this clause to remain in the final version of the ACA, a horrifying truth is revealed: the “Readmissions Reductions Program” is clearly biased toward higher socioeconomic communities.
A significant — and sadly unsurprising— body of evidence exists revealing that citizens in lower socioeconomic communities, and especially the racial and ethnic minorities who tend to inhabit those communities, face a variety of different health treatment disparities. These disparities derive partly from unequal treatment at healthcare facilities and disproportional representation in clinical trials, though to a greater extent they are caused by limited access to certain facilities and resources that are vital to proper care. And, because those of lower socioeconomic status face a variety of barriers to proper treatment, they are far more susceptible to suffer from certain debilitating illnesses like diabetes and heart disease, an idea I touched on in an article published a few weeks ago.
Health treatment disparities cause hospitals that treat disadvantaged people to be far more likely to readmit patients within the post-discharge 30 day period, as people who receive lower quality treatment are naturally more likely to experience illness more frequently. As a result, the federal government has declared by proxy that hospitals consistently treating patients of lower SES should be penalized for their inefficiency, even though these hospitals are only partially responsible for their patients’ heightened propensity to suffer from certain illnesses.
Healthcare issues are rarely as simple as legislators and politicians make them seem, as the powerful allure of monied interests often skews the line between right and wrong, between the balance of basic morality and economic efficiency. Currently, the Readmissions Reduction Program has practically no provisions for hospitals that serve greater populations of patients experiencing health disparities, and these institutions are suffering as a result. Hospitals that are already facing greater difficulties in healing patients are being penalized due to factors that exist outside of their control, creating a vicious downward cycle that will continue to deteriorate quality of care as long as this program exists.
Thankfully, a bill has been introduced in Congress that will address this overt injustice by reducing punishments for hospitals that consistently treat lower SES patients, though Congress, as always, has been slow to act on this well-intentioned reform. The dollars they don’t receive from readmissions penalties, after all, will restrict their ability to fund causes they may deem “more important.”
The lagging effort to right this wrong is inexcusable. The ACA was designed to reduce healthcare disparities; it is time for our legislators to act and make sure it accomplishes its goal.
Ryan Gorman is an Opinion columnist for The Cavalier Daily. He can be reached at r.gorman@cavalierdaily.com.
Read More
PARTING SHOT: No man is an island
By Ava MacBlane | 2 days agoRetirement, as you can tell, has been treating me well. When people ask me now if I miss it, I laugh and tell them some things I definitely don't miss. But I don't always get to tell them about the things I really do miss.
PARTING SHOT: You never know unless you try
By Lexi Baker | 3 days agoMy time at the University was shaped by the people who showed me grace and kindness and by those who had confidence in me, even when I struggled to have it in myself.
PARTING SHOT: A love letter to Cav Daily and Connection
By Ava Proehl | 3 days agoMy time here taught me to look for the genuine, human connection in every moment.
