Hospital Re-Admissions — the revolving door

revolving door

Hospitals have ignored the obvious problem of patients returning to the hospital soon after discharge.   Decades of re-admissions have enriched hospitals — same charges over and over.  Now re-admissions for heart attacks, heart failure and pneumonia lead to Medicare penalties.  The problem is widespread and as always worse in some parts of the country.

Pneumonia Readmissions

The above graph comes from a an excellent Medicare study.  It show a high rate of re-admission after pneumonia in some areas (dark blue).  It should come as no surprise that some hospitals have been able to quickly drop the re-admission rate by 20% (because they were not trying very hard before).

Why did hospitals not care?

  • Re-admissions were profitable
  • Avoiding re-admission was considered an outpatient problem
  • It was the patient’s fault for not taking the medications they were prescribed at discharge (no matter what the cost).
  • Hospitals have no control over outpatient doctors.

What changed?

  • Dr. Donald Berwick cared.  He was the administrator of Medicare who initiated the penalties.
  • Hospitals purchased doctor practices — so now they really do control the outpatient doctors and thus assume a greater responsibility.
    •  Over 75% of cardiologists work for hospital systems
    • Over 50% of primary care work for hospital systems
    • Many health systems operate visiting nurse services.
  • Hospitals have no excuse for failing connecting discharged patients with primary care (they own primary care)
  • Hospitals have no excuse for failing to engage patients in heart failure clinics (they own cardiology).
  • Hospitals must take an interest in what medications are prescribed at discharge — the right medications and generic medications if possible.

What can patients do to cut the odds of re-admission?  According to a report by Jason Kane of PBS there are 7 things a patient can do:

  1. Work with the hospital to plan ahead (days before discharge)
  2. Understand your illness and ask questions about your health care
  3. Have a written discharge plan
  4. Understand your medications
  5. Don’t go it alone
  6. Follow through with follow-up care
  7. Find out how good the care is in your community for patients leaving the hospital.

A word of caution:  just because you have been re-admitted, it does not mean you need to be on hospice care — indeed that will stop re-admissions but perhaps not the way you want (dead patients don’t return).

Your ace in the hole:  strong primary care.  The hospital team MUST communicate with primary care — make sure they do.  A quick follow-up appointment and several short interval appointments will help to get back on track with the management of chronic illnesses.  If you were just in the hospital for a heart attack, congestive heart failure or pneumonia (or other chronic conditions) an appointment in 6 months is totally inappropriate.

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