Patients discharged from America's hospitals return much sooner than one might expect, exacting an enormous and unnecessary human and financial toll. The good news is that an estimated three quarters of those readmissions could be prevented. There's also good news in that patients can help reduce their own chances of readmission.
The cost of unnecessary hospital readmissions is astonishing. A study released last month shows that reducing avoidable hospital readmissions by just one day, in California alone, could save government health care programs $227 million a year, according to the California Discharge Planning Collaborative. An earlier study by the Medicare Payment Advisory Commission (MedPAC) estimated that in 2005 Medicare paid $12 billion for readmissions that could have been avoided.
The extent of readmissions is also extraordinary. Nearly 20 percent of patients who had been discharged from a hospital were re-hospitalized within 30 days, according to a landmark study, published in 2009 in the New England Journal of Medicine, which analyzed approximately 12 million fee-for-service Medicare beneficiaries. Thirty-four percent were re-hospitalized within 90 days; 56.1 percent within a year. Of those discharged after having surgery, a staggering 51.5 percent either died or were readmitted within a year of discharge. Yet the vast majority of these readmissions are avoidable - three quarters might have been prevented, according to a 2007 report by MedPAC.
As Patient Safety Awareness Week is observed (March 6-12), it's an especially good time for health care consumers and hospital executives alike to consider the causes of these numbers and what can be done about them. A crucial factor is a lack of communication between health care providers and patients at the time of discharge from the hospital. And with the amount of time patients stay in hospitals becoming shorter and shorter, it's more important than ever that accurate post-discharge medication dosages and times be communicated effectively.
A key finding of the landmark 2009 study was that half of all patients re-hospitalized within 30 days had no record of outpatient care following their initial discharge. As much as three months after leaving the hospital, one in five patients still had not been seen by a physician or care provider.
These are not conceptually difficult issues to address; it's the consistent implementation that is hard to achieve on a large scale. Fortunately, the federal government has gotten the hospitals' attention. Beginning this fall, under the federal health care reform law, hospitals will start to pay penalties if their readmission rates are higher than expected in certain areas.
Still, health care consumers should not leave their recovery in the hands of others; they should take charge. Here are some tips to observe:
* Ask the hospital to provide detailed written instructions on discharge, explaining what you need to do to take care of yourself. These instructions should include what medications to take, how to continue treating any wounds, what to eat, and how much to exercise, among other things. Insist on having them in writing; you have that right.
* Ask a family member or friend to be with you at discharge, so that another person understands clearly what is needed. Patients often do not feel well enough to focus intently on what's said.
* Be sure that you schedule a follow-up visit with your doctor to ensure that you are following the proper procedures. Appropriate monitoring by your primary care physician or his or her staff is essential.
* Take advantage of the free online tools and resources - available at the National Patient Safety Foundation's website - designed expressly to help you become an active participant in your health and the safety of the care provided to you and your family.
Unnecessary hospital readmissions have become exorbitantly expensive and excessively wasteful. They will clearly be reduced dramatically in the years ahead. In the meantime, consumers should take it upon themselves to see that they don't become an avoidable readmission.
The author is President of the National Patient Safety Foundation (www.npsf.org).
Bundled payments mean the hospital/doctor get paid one lump sum for the diagnosis so it behooves the hospital to get them out as soon as possible and save money. "Utilization review nurses" are always hounding the doctors to get the patient out as soon as possible. Cobine that with the low ( and dropping) Medicaid/Medicare payments, you can count on this getting worse .
While I agree that poor communication with a PCP in the era of hospitalist directed care is a potential issue, most hospitalists strive to have a discharge summary completed on the day of discharge and transmitted to a PCP. Normally, there is a direct call between the two as well.
A major factor is lack of patient followup. It sounds like an easy fix, but how many of the patients do not have a PCP to follow up with? In urban areas, this is a significant problem without easy resolution, given the shortage of primary care physicians. Fast forward to 2014, when more patients become eligible for health care coverage, and the problem becomes even greater.
In my experience, providing discharge instructions exclusively at the time of discharge is a huge blunder. Patients are dressed, distressed, and anxious to leave what probably was an unpleasant experience. They will sign anything and their focus is not at the instructions being provided, but on returning home. Nor is this the time to discover that the patient cannot read.
Following discharge, poor care provided either by a practitioner or a nursing home may culminate in readmission. Penalizing the hospital is missing the target.
The good news is that there are many interventions which can reduce readmissions. Space does not allow me to address these.