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Hospital fines raise questions about wisdom of Medicaid expansion

by The Oklahoman Editorial Board Published: August 18, 2013

ADVOCATES of Medicaid expansion argue that Oklahoma hospitals will be financially harmed and perhaps forced to close if the state doesn't embrace the expansion portion of Obamacare, regardless of the cost to Oklahoma taxpayers.

Yet the Obama administration's recent actions undermine those arguments by suggesting that some closures aren't necessarily bad. The federal government has fined 2,225 hospitals nationwide — about two-thirds of all hospitals — based on the readmission rate of Medicare patients within 30 days of treatment. In Oklahoma, 53 of 91 hospitals were penalized. Those fines are the result of provisions of Obamacare supposedly designed to pay hospitals for the quality of care provided rather than the number of patients treated.

The fines raise several questions about the wisdom of Medicaid expansion. Based on the Obama administration's own actions, Medicaid expansion would subsidize dozens of state hospitals that the administration believes are providing substandard care.

Eight of 22 Oklahoma City-area hospitals were fined, as were eight of 14 hospitals in Tulsa and its suburbs. A Durant hospital was just one of 19 nationally to get the maximum penalty, while a hospital in Hollis cracked the national top 25 in the percentage size of its penalty.

Therefore, one argument for Medicaid expansion can be summed up as follows: If Oklahomans don't increase hospitals' taxpayer subsidies, citizens could lose access to low-quality health care in poor-performing facilities. This isn't a great selling point.

On the other hand, hospital officials can reasonably argue that readmission rates don't necessarily indicate poor quality care. Many patient problems requiring readmission are the result of a patient not abiding by doctor's orders at home. The hospital can't be blamed for that. And some complications simply can't be predicted. It's not realistic to expect that no complications will ever occur in the aftermath of heart attack, heart failure or pneumonia (the cases federal officials used for their ratings).

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by The Oklahoman Editorial Board
The Oklahoman Editorial Board consists of Gary Pierson, President and CEO of The Oklahoma Publishing Company; Christopher P. Reen, president and publisher of The Oklahoman; Kelly Dyer Fry, editor and vice president of news; Christy Gaylord...
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