Readmissions

Nothing bugs a hospital administrator like lost money.  It drives them crazy.   It gives them nightmares at night.  It is how they are judged by their board.   Readmissions to hospitals, within 30 days, is keeping this curse going now that Medicare is penalizing hospitals if they don’t stop this trend.  In fact, hospitals would be better off financially if those patients succumbed versus leaving and coming back in (how is that for a potential plot twist for a movie?).  Here is a link to a great article in the WSJ which explains this more and here are some highlights:

  •  The Center for Medicare and Medicaid Services said it is trying to reduce “avoidable hospital readmissions, which cost Medicare $26 billion a year and affect nearly one in five beneficiaries.” The approaches include better discharge planning, home-based follow-up and patient education, according to the federal health agency.
  • A study led by researchers at Yale University of four million patients aged 18 and older with multiple conditions in three states found nearly 20% ended up back at the hospital within 30 days. Emergency-department visits accounted for about 40% of post-discharge hospital-care use, which the researchers said indicates more attention is needed to prevent such emergencies, even though they may not result in readmission. High rates of ER visits after hospital discharge may reflect shortcomings in care in the transition from hospital to home, they added.
  • Another study of three million Medicare patients from 2007 to 2009 by researchers at Yale and Columbia University found that nearly 25% of those with heart failure, 20% of heart-attack patients and 18% of those with pneumonia were readmitted within 30 days, often for the same condition but also for a wide variety of other diagnoses.

So you would think fixing this would make things better, right?  Not so:

  • A study led by the Colorado Foundation for Medical Care found that communities that created programs to improve care transitions in a program funded by Medicare were able to reduce readmissions compared with those without such programs, but not enough to drive them down significantly as a percentage of hospital discharges.

You see, Pay-for-Performance does not work!   Sure, better coordination is needed.  Sure, more social services are needed.  Sure, quicker follow-up with the doc is needed.  Let’s keep working on that.  I am all for system improvements but the one thing that is never mentioned is that patients don’t have any skin in the game.  You can’t stop some heart failure patients from going home and marinating themselves in salt.  You can’t stop some COPDers from literally living in a terrarium of toxic smoke.   And yet we doctors, who know and understand this, will just let the “smarter” people make the rules…..evidence be damned.

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