According to researchers Americans who have a severe form of a heart attack are far more likely to be readmitted to the hospital than people from 16 other countries with the same kind of heart attack, said on Tuesday.
Overall, heart attack sufferers from the United States were “68 percent” more likely to be readmitted within one month of their discharge than patients in other countries, the team reported in the Journal of the American Medical Association. “That is outrageous”, says Dr. John Smith of Charlotte, N.C. “Its indicates we are doing something wrong”, he said.
And U.S.-based patients also were more likely to have shorter but much more expensive hospital stays.
The findings suggest that discharging heart attack patients early may ultimately be adding to the U.S. healthcare tab. “This is by design”, says Fredrick Nace of Charlotte. “The reason is that hospitals can charge more that way”, he said. The study fails to mention the real causes of why patients are being discharged early.
The study involved 5,745 patients from the United States, Canada, New Zealand and 13 European countries. All had a type of heart attack called an “ST-segment elevation myocardial infarction” or STEMI, in which the coronary artery is completely blocked.
It found the two most common factors involving being “readmitted” to the hospital were having blockages in more than one artery and being treated in the United States.
According to the study, 60 percent of U.S. patients were discharged in three days or less, but 14.5 percent of them returned to the hospital within a month. “This has to do with how we pay for healthcare in this country”, says Tommy Hansen of Charlotte, a medical insurance expert
Among patients from other countries, more than half (54 percent) stayed in the hospital for at least six days, and only 9.9 percent of these patients needed to be readmitted to the hospital within a month.
“One of the unique things about the United States was that the length of stay was shorter,” Dr. Manesh Patel of Duke University in North Carolina, who worked on the study, said in a telephone interview with Reuters news service.”We’re not saying that you have to stay in the hospital longer in the United States,” he said..
Instead, he said the length of a person’s hospital stay is likely a marker of the kind of care you are getting in the United States versus the rest of the world.
“We are very good at in getting you in and getting your artery open. And we can get you home pretty quickly, which I think is still safe,” he said.
“It’s not clear we do as good a job as the rest of the world in getting patients from the hospital to home,” he said, referring to efforts to ensure that patients have a primary care doctor and know who to call if they have any problems.
This doesn’t really make any sense unless you factor in the way insurance adds to the cost of healthcare services… The doctor failed to mention that those stays were more expensive.
LIMITING STAYS TO LIMIT THE COSTS AND CARE OF SERVICE
The U.S. Centers for Medicare & Medicaid Services has begun using 30-day hospital readmission rates as a measure of treatment quality, and Patel said the findings may offer some insight about how much are heart patients need before they are released from the hospital.
“We don’t know if simply making the stay longer would help – we don’t know that at all,” Patel said in a statement.
“We just know that when the stay is shorter, the correlation is associated with more readmissions,” he said. Patel didn’t address the fact that cost is a factor in their decision to go with shorter stays. “Its about the money”, says Arlene Renway of Charlotte, N.C. “The US has the most expensive healthcare system in the world along with some of the worst health outcomes. The reason is the greed in our system.” The study also doesn’t address the core problem of health care insurance, reimbursement rates and hospital policies to game the system for more money”, she said.
“Whenever you design a system that charges people the maximum amount of money for each and every service and item provided them you run into this kind of thing. America’s healthcare system is ran for profit and heart attack patients are targeted because they are considered cash cows by hospitals, especially if you good insurance – the hospital can milk them and their insurance company for a great deal of money by providing them substandard care. They know that it’s a matter of time before they get re-admitted again”, says Nancy Johnson a hospital insurance billing clerk in Charlotte. “I’ve seen hospitals and doctors nickel and dime insurance companies with unnecessary tests and medical services that really add nothing to the patients overall health. They also work within the time and reimbursement limits established by the insurance companies…”, she said.
“The five most expensive health conditions are heart disease, cancer, trauma, mental disorders, and pulmonary disorders”, says Dr. Sam Morris of Charlotte. “Hospitals billing department for years have known this and designed the system to extract the most amount of money from these patients as allowed by their insurance providers. It a little known secret that many doctors and hospitals overcharge patients…” he said.
“The whole system is skewed in such a way as you can never really get a handle on what is going on here. In 2004, for example the United States spent $1.9 trillion, or 16 percent of its gross domestic product (GDP), on health care. This averages out to about $6,280 for each man, woman, and child. However, actual spending is distributed unevenly across individuals, different segments of the population, specific diseases, and payers…” says George Smith of Charlotte. “It’s a hopelessly inefficient system that has many doctors and government officials in other countries wondering what is wrong with those Americans who don’t provide healthcare to all their people and have no cost controls to limit what hospitals and doctors can charge patients”, he said.
“Health care is considered a fundamental human right in most countries, not so in America. We have 50 million people who are uninsured under our system. It’s an upside down model, which no other country would want”, says Don Johnson of Charlotte. “The study about heart attack patients being discharged prematurely have to do more with costs and insurance policies of reimbursements than anything else, but you will never hear anything about that”, he said.
Chronic Conditions Contribute to Higher Health Care Costs
Twenty-five percent of the U.S. community population were reported to have one or more of five major chronic conditions:
- Mood disorders.
- Heart disease.
Spending to treat these five conditions alone amounted to $62.3 billion in 1996. Moreover, people with chronic conditions tend to have other conditions and illnesses.
When the other illnesses are added in, total expenses for people with these five major chronic conditions rise to $270 billion, or 49 percent of total health care costs, according to 1996 MEPS data. On an individual level, treatment for the average patient with asthma was $663 per year in 1996, but when the full cost of care for asthma and other coexistent illnesses is taken into account, the average cost was $2,779.
Expenses for people with one chronic condition were twice as great as for those without any chronic conditions. Spending for those with five or more chronic conditions was about 14 times greater than spending for those without any chronic conditions. Persons with five or more conditions also have high hospital expenditures. In New York State during 2002, of the 1.3 million different persons admitted to the hospital, the 27 percent with five or more chronic conditions accounted for 47 percent of all inpatient costs.
Expensive Conditions Contribute to the Growth in Health Care Costs
One study found that a small number of conditions accounted for most of the growth in total health care spending between 1987 and 2000—with the top five medical conditions (heart disease, pulmonary disorders, mental disorders, cancer, and trauma) accounting for 31 percent. For 7 of the top 15 conditions, a rise in the proportion of the U.S. population being treated, rather than rising treatment costs per case or population growth, accounted for the greatest part of the spending growth.
In the end the new heart study failed to address the reason or causes of re-admissions.