Better follow-up care could reduce hospital readmissions
By T. Brian Callister, MD
This article appeared originally in the fall, 2009 issue of Continuum, the quarterly journal of the Acute Long Term Hospital Association and is reprinted with permission.
A recent Medicare study, published in the New England Journal of Medicine, reports that a great many hospital readmissions could be prevented with more effective follow-up care. According to the study, an estimated one-fifth of all Medicare hospital patients are readmitted within a month of discharge, and a third of Medicare patients are back in the hospital within 90 days.
Published reports say the study included information on 12 million patients and analyzed Medicare claims from 2003-2004. Unplanned readmissions to the hospital (rehospitalizations) cost about $17.4 billion annually. President Obama’s budget, published in February, 2009, notes that cutting back on readmissions could save $26 billion in a decade.
The study also revealed that almost two of every three Medicare patients were readmitted or died within a year. And there were great variations in the rehospitalization rates based on location. For example, the rate of rehospitalization within 30 days was 13.3 percent in Idaho, but 23.2 percent in Washington, D.C. The most common reasons for rehospitalization were heart failure (8.6 percent), pneumonia (7.3 percent), psychoses (4.3 percent) and COPD (3.9 percent).
Study author Dr. Eric Coleman, of the University of Colorado, is quoted as saying, “Hospitals put more effort into the admission process than they do into the discharge process.” He notes that when patients get home, they may become confused about medicine or have other problems, and go straight back to the hospital because they don’t know where else to get help.
Stephen F. Jencks, a former Medicare official who is now a private medical consultant, suggests hospitals should provide more aggressive post-discharge care. Publicizing hospital readmission rates and establishing Medicare incentives based on those rates would also help solve the problem, he said.
In an editorial in Modern Healthcare, Dr. Arnold Epstein of the Harvard School of Public Health notes: “The challenge is to create shared incentives to provide more efficient care and better coordination of care between inpatient outpatient domains.”
Efforts to break the readmission cycle will require educating communities and medical professionals about the
options for patients upon hospital discharge. Many are not familiar with the services available at specialty hospitals (also called complex care hospitals and long term acute care [LTAC] facilities). These hospitals provide a unique level of patient care by providing extensive rehabilitative therapies in a critical care setting.
In other words, patients that are stable, but still require intensive or critical care services, such as those dependent on a ventilator or those with multiple conditions and complications, can receive this level of critical care, while also making strides toward a full recovery with various restorative therapies. This story illustrates that incorporating specialty hospitals into the patient care continuum can significantly reduce readmissions and improve patient outcomes, while saving hospital and federal dollars.