Readmissions

Hospital readmissions are a huge problem because many of them can be prevented.   This is why the government and insurance companies are squeezing hospitals and holding their feet to the fire by penalizing them if those readmissions do occur.   Call it a carrot or a stick but the result is the same.  “Readmission rate” is the poster child for the quality movement.  The problem is that many of those readmissions also cannot be prevented.  A new study  found that one-third of adult patients discharged from a hospital do not see a physician within 30 days of release, putting them at risk of readmission. About 8% of discharged adults were rehospitalized during that time, while 33% were readmitted within a year.  This is all explained in a recent American Medical News article.   The cause of this lack of follow-up is explained as a “systemic breakdown” with a need for a “system of providers” working together to solve it.   They recommend greater hospital/physician collaboration and better tracking technology.   Lastly, they state this is an area of opportunity for primary care doctors to step up to the plate.    You know what?  I agree with all of this.  I really do.  In a perfect world there needs to be good follow-up, perfect handoffs, seamless technological record release and so on.  Let’s make it happen.  Oh, but there is one other thing.  As mentioned in a recent blog where I showed you that half of post-MI patients stop taking their medications within a year even though it was given to them for free, I think somewhere in the article it should be mentioned that personal responsibility is pretty important as well.  Doesn’t that sound reasonable?   Amazingly enough, doctors are NOT the cause for all things going wrong in the healthcare system.  Maybe, just maybe, we can mention that having some healthy habits like eating right, keeping a proper weight, exercising, sleeping well, not smoking or doing drugs, taking your medications and following up the doctor is actually part of that personal responsibility.  And penalizing doctors for those things NOT happening is, well, asinine.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Readmissions

  1. Ryan Ridenour
    December 28, 2011 at 12:30 pm

    piggybacking on that – how about the new study released this week – i believe in today’s hospitalist – showing that the hospitals at highest “risk” for readmissions on the hot-button conditions of heart failure and pneumonia were – get this – the hospitals that had the highest incidence of INITIAL admissions for heart failure and pneumonia. kinda sounds like sick people are sick; when someone’s sick enough to get admitted, they’re also sick enough to have a risk of “re-decompensating” after they appear to be better. agree totally on the patient responsibility part – given that the only 2 studies i’ve ever read showing even small cutdowns on readmissions are programs that are very intensive in communication with the patient (to ensure med compliance / lifestyle compliance / follow up compliance)

  2. December 25, 2011 at 5:02 pm

    Physician quality has only a 10% impact on patient health! So our “control” on the issue of readmissions, admissions, or the patient’s health is minimal at best. See a most revealing article in this month’s Scientific American citing research from countyhealthrankings.org and the Universities of Wisconsin and Kansas.
    Access to care 10% so having lots of very good docs gives you a total of 20%.
    The balance is lifestyle, education, social support structure, environment. Do you wonder when HHS will discover the results of studies they are funding?? Nah…still our fault.

  3. Diane Haugen
    December 25, 2011 at 11:58 am

    All good points, but why are none of these policymakers considering the possibility that gee, maybe three days of acute care isn’t enough for some patients? And the really revolutionary notion — that perhaps the treating physician is the most qualified to make that decision.

    Many of the patients who find their way into our local, rural hospital have been dumped out of the metropolitan center hospitals in the required three days, sick and unable to be cared for at home. Or worse, sicker because they weren’t there long enough for the really deadly results of their surgeries or illnesses to surface.

    These patients never make it to follow up appointments, not because they are noncompliant, but because the care they received was woefully inadequate largely because of the very regulators who are trying to blame the patients for not keeping followup appointments.

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