In the wake of the Affordable Care Act, there is an increased focus upon hospital readmissions and the financial penalties for hospitals with the highest readmission rates. In 2012, almost one in five Medicare patients were readmitted within 30 days, leading to almost $280 million in forfeited Medicare payments for the 2,217 hospitals with the most egregious records. In 2014, the number of hospitals penalized by Medicare grew to 2,610, a record number, with a total loss of $428 million in Medicare funds. Much of this is spurred by preventable readmissions that are costing Medicare almost $26 billion; it is estimated that almost $17 billion of these expenditures could be saved with proper medical care following discharge.
Although there have been a number of studies identifying the highest risk groups for readmission like myocardial infarctions, there are no reliable markers for patients likely to return for hospital care for preventable health complications. A study by Lee Lindquist found that there are some independent qualifiers which may signal preventable hospital readmissions like depression, narcotics use, steroid use and African-American heritage.
In light of the considerable funds lost due to unnecessary hospital readmissions, it is incumbent upon caregivers to optimize recoveries. One of the most powerful ways of ensuring proper stabilization and recovery is to partner with home care agencies that use nurses or social workers to visit recovering patients, monitor their health and bridge the gap between physicians and patients. It should also be noted that while the elderly are the most likely to return, almost 20% of readmissions, for hospital care, this readmission reduction strategy (and others) should be applied to as many at-risk patients as possible. Furthermore, it is wise to include the personal physician for the patient in any follow-up care regimes in case the patient is more comfortable discussing issues with them.
The traditional approach to post-operative or post-therapeutic care is to verbally instruct the patient while providing written instructions to reinforce physician's directions. While this may sufficient in the majority of hospital releases, it may not be enough for elderly, non-English speakers, uninsured, or the physically or mentally challenged. Many hospitals are employing more proactive strategies like sending medications home with the patient, having a healthcare extender call the patient, or even scheduling a visit from a member of the healthcare team. These follow up interactions can pinpoint an emerging health issue before it prompts a visit to the ER.
Robust follow up care should emphasize proper instruction for at-risk patients. For example, one of the most common complications leading to hospital readmissions is pharmacological mismanagement. Whether the patient is incapable of acquiring the right medications, has issues remembering to take them or misunderstands dosage requirements, a simple phone or Skype call to the patient or a family member may be sufficient to prevent this relatively simple problem from evolving into a crisis.
Finally, for those patients with a number of serious health issues, like depression or dementia, it is wise to apply all of these strategies. Some major hospitals like Piedmont Hospital in Atlanta identify at-risk patients and introduce them to local social agencies. By the time the procedure is completed, these agencies are waiting for the patient and are already prepared to oversee their recovery.
Hospital readmissions has long been a serious challenge to the healthcare community. There are many factors which can contribute to this, but with a few, relatively inexpensive policy implementations, hospital readmissions can be dramatically reduced, preserving medical resources for the most needy and avoiding severe financial penalties.
Article written by:
Robert Moghim, M.D.
CEO, Health Carousel Locum Tenens