Hospital Readmission; Every American hospital has two front doors: The real one, and an imaginary revolving door. Any patient who winds up back in the hospital within a few weeks of getting out travels through that imaginary door. And the more of them there are, the more money their hospital stands to lose from the Medicare system.
This readmission penalty, as it’s called, aims to spur hospitals to prevent unnecessary costly care. But a new study shows that after several years of rapid improvements in readmissions, the readmission penalty program may be spinning its wheels more than it’s slowing the spinning of the revolving hospital door.
The Hospital Readmission
Writing in the journal Health Affairs, a team from the University of Michigan reports findings from their analysis of data from nearly 2.5 million Medicare patients. They focuse on those who had hip or knee replacement surgery; so before and after penalties affecting these operations were announce. In fact, the readmission rate for these patients had; so already start dropping by the time the idea of readmission penalties; which was announce as part of the Affordable Care Act in 2010.
These findings raise the question of whether they’re about to reach the floor; so in our ability to reduce readmissions for these patients,” says Karan Chhabra, M.D., M.Sc., the study’s lead author. At the same time the readmission rates were changing; so the average cost of caring for a Medicare hip or knee replacement patient did too; hence the new study shows. In fact, it dropped by more than $3,000 from 2008 to 2016.
And hip and knee patients’ chance of heading home from the hospital; so rather than to a skilled nursing facility or other setting, has increased over that time, the researchers report. So has the likelihood that they will have home health aide help when they get home. The same efforts that hospitals may have launch to prevent readmission of medical patients; which may have extend to these surgical patients, the authors speculate.
The Medicare patients
These might include care coordination programs and telephone check-ins with recently discharge patients, or better patient education about home care or changes to their medications. The Hospital Readmission Reduction Program, or HRRP, still carries large penalties up to 3% of what a hospital earns for certain Medicare patients. Not only that, it has expand to include more conditions, including heart bypass surgery and more types of pneumonia including those with sepsis.
Instead, the researchers suggest that more use of bundle payments where Medicare sets a define amount of money it will pay for the episode of care surrounding a surgical patient’s operation could produce better results. This is because bundle payments ensure hospitals focus on costs and complications around the entire episode of care, not just one narrow metric like readmissions.
Patients and the loved ones who will care for them should also make sure they understand the instructions they receive at hospital discharge, and know what kinds of symptoms or changes should prompt them to contact their team. Often, their surgical teams can provide instructions or reassurance that can prevent a bounce back to the emergency department. That kind of open communication can make the difference between an appropriate and an inappropriate rehospitalization.