Bill Bars Early Release in Medicare Cases

A bipartisan group of powerful House and Senate members, charging that hospitals are trying to save money by discharging Medicare patients “quicker and sicker,” introduced legislation Thursday that they said would protect patients’ rights and assure quality care.

Too often, Senate Aging Committee Chairman John Heinz (R-Pa.) told a news conference, “hospital administrators try to push doctors to push patients out the door, and doctors must say no.”

Heinz and Rep. Pete Stark (D-Oakland), chairman of the House Ways and Means subcommittee on health, introduced a bill to bar hospitals from sending Medicare patients home against a doctor’s wishes. Patients who object to a hospital’s decision to discharge them would be guaranteed up to three days of free hospital care while the hospital considers their appeal.

Cash Bonuses Prohibited

The bill also would prohibit hospitals from giving cash bonuses to doctors who meet cost-saving targets when treating Medicare patients.

The legislation is designed to ease the impact on patients of the strict cost-control method of Medicare payments Congress put into effect for the nation’s hospitals in 1983. Instead of simply reimbursing hospitals for their costs, Medicare now pays hospitals a fixed sum for each of 467 medical conditions.

If a hospital treats and discharges a patient for less than the prescribed payment, it can pocket the difference as profit. If the cost of care exceeds the government allowance, however, the hospital must absorb the loss.

6% Inflation Rate

This approach has helped curb runaway increases in spending for Medicare, which pays most hospital and doctor bills for 27 million Americans over age 65 and 3 million disabled persons of all ages. Heinz said that the new system saves Medicare $3 billion to $4 billion a year and helped cut the hospital inflation rate to 6% last year, the lowest level in 20 years.

But it also has provided hospitals with a strong financial incentive to send patients home as quickly as possible. “Medicare is trying to hold the line on costs, and properly so, but that doesn’t mean that providers can cut corners on quality,” Stark said. “We’ve heard that’s what’s happening. We’re mad and we want it to stop.”

‘Sooner and Sicker’

The legislation would order the federal government to pay hospitals extra for particularly severe or complex ailments. In the absence of such legislation, another sponsor, Edward R. Roybal (D-Los Angeles), chairman of the House Aging Committee, told the news conference, “people are released every hour . . . sooner and sicker.”

A hospital group responded by opposing the legislation.

“We’ve been hearing this same old song, especially from Heinz, for more than a year now, about sicker and quicker,” said Clay Mickel, director of communications for the American Hospital Assn. “Unfortunately, he dwells on something that we have no indication is a widespread problem.”

He said that the association has cooperated with the government in preparing a notice of Medicare patients’ rights that is now being distributed in hospitals.

“Just as Sen. Heinz does, we think one premature discharge is too many,” Mickel said. “But when you look at millions and millions of discharges, you’ve got to strike a balance and realize there are going to be some questionable discharges in that sample.”

Coalition of Legislators

The bill is being backed by a coalition of legislators from both parties, spanning the political spectrum. The co-sponsors include Sen. Dave Durenberger (R-Minn.), chairman of the Senate Finance subcommittee on health; Sen. John Glenn (D-Ohio), ranking Democrat on the Senate Aging Committee; Rep. Henry A. Waxman (D-Los Angeles), chairman of the House Commerce subcommittee on health, and Rep. Bill Gradison (R-Ohio), ranking Republican on the Ways and Means health subcommittee.

The American Assn. of Retired Persons will mount a grass-roots lobbying campaign for the legislation, executive director Cy Brickfield told the news conference. Backing was also announced by Dr. Joseph F. Boyle, executive vice president of the American Society of Internal Medicine.

Meanwhile, the Health Care Financing Administration, which administers the Medicare program, announced that it expects the deductible for hospital insurance under Medicare to rise in January to $572. The deductible, which currently is $492, is the sum that Medicare beneficiaries must pay themselves and equals the cost of an average day in a hospital.

The deductible is being forced higher as hospitals cram more tests and treatments into fewer days in their effort to discharge patients sooner, government health-care officials said. Roybal and Stark have introduced legislation to freeze the deductible.