Hospitals; 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.
Average cost of caring
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, the new study shows. And hip and knee patients’ chance of heading home from the hospital; so rather than to a skilled nursing facility or other setting; which has increase 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; hence to prevent readmission of medical patients may have extend to these surgical patients, the authors speculate. 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; so 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; which including heart bypass surgery and more types of pneumonia including those with sepsis. But Chhabra and his colleagues say that adding more conditions to the program; which is not likely to result in much more readmission prevention or cost savings.
“Based on the experience so far, it’s hard to believe that adding on penalties; hence for more conditions will further bend the curve of readmission,” says Chhabra, a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation who is also a resident in the Department of Surgery at Brigham and Women’s Hospital.
Ensure hospitals focus
In the end, some readmissions are inevitable, the authors say; also trying to drive rates lower through penalties may mean some patients who should have been readmit to deal with an issue won’t be. 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. In the meantime, Chhabra says, patients who get hospitalize for surgery or any other reason should make sure to know what their lines of communication back to their care team at all hours after they leave the hospital.
Patients and the love 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.