Reducing hospital readmissions: It goes beyond the hospital setting

Susan Pantely discusses the importance of reducing hospital readmissions and the risks associated with multiple hospital visits.

By Susan Pantely, Principal & Consulting Actuary, Milliman Inc.

susan pantely Reducing hospital readmissions has emerged as a major issue in healthcare economics and become a priority for the Centers for Medicare and Medicaid (CMS) and commercial insurers alike. One of the primary reasons is the significant cost associated with readmissions. A study published in the New England Journal of Medicine found that nearly 20% of Medicare patients in 2003-2004 were back in the hospital within 30 days of a discharge, and that 34% were re-hospitalized within 90 days. The study estimated the cost of the unplanned re-hospitalizations in 2004 at $17.4 billion. CMS will begin penalizing hospitals with higher than average readmission rates for targeted conditions in 2013. Traditionally, hospitals have focused on care given within the facility. Now, hospitals will have to look beyond their four walls and be concerned with patients after discharge.

However, cost is not the only factor and risk to manage – quality of care is another reason to reduce readmission rates. Let’s face it – no one wants to be in the hospital. Not only that but hospitalizations can lead to nosocomial infections and other adverse events.

No one knows exactly how many readmissions are preventable in the healthcare system – however, most experts agree the number of preventable admissions is significant. There is wide geographic variation that suggests many readmissions are preventable. Additionally, many adverse events reported after discharge are drug events which are most often preventable.

One thing is certain – reducing hospital readmissions will require initiatives beyond the hospital setting. Readmissions are often a result of what happens once the patient is discharged rather than inadequate care while hospitalized. Hospital readmissions are often the result of inadequate discharge planning, inadequate discharge follow-up and lack of care coordination. Patients often have a lack of understanding of medication instructions and other instructions such as diet and weight. Additionally, patients often don’t understand the warning signs that should be communicated to their physicians. Other potential areas of improvement aimed at reducing readmission are communication of patient hospitalization and discharge status to their primary care physician.

Hospitals will have to team up with primary care physicians and other care coordinators to be in contact with the patient post-discharge. These care coordinators will discuss medication side effects, compliance with medication, compliance with diet, and other measures in an attempt to prevent readmissions. If successful, significant savings will be achieved – and we’ll have a happier, healthier patient.

Are there additional methods can be implemented to reduce hospital readmission rates? What should the role of the primary care physician be in preventing readmissions?

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