Readmissions come back to bite hospitals|
Readmissions come back to bite hospitals
By Suzanne Hoholik
Hospitals need to do a better job of educating patients about their illnesses, making sure they understand new diets and prescriptions and getting them to see their family doctor two weeks after discharge, according to a national report today.
Not doing those things could bring patients back to a hospital within 30 days. And starting next fall, Medicare will penalize hospitals for those “avoidable readmissions.”
The report released today by the Dartmouth Atlas of Health Care found that hospitals have done little to reduce the number of Medicare patients with congestive heart failure, heart attacks, pneumonia or hip fractures who quickly return to the hospital.
The New Hampshire-based health-policy group compared 2004-09 claims data from 94 academic medical centers, including Ohio State University Medical Center.
“For a longstanding and well-recognized problem, not much progress has been made,” said Dr. David C. Goodman, author of the report and an investigator at Dartmouth. “There’s not a place that stands out in having exceptionally low readmission, at this point.”
More than 9 million Medicare beneficiaries are hospitalized each year, and 1 in 5 will be back within 30 days, the report found.
Readmissions cost Medicare, the government insurance for the poor and elderly, $17 billion a year. As the penalty looms, hospitals are working to change this.
“It is indeed a problem we all need to address collectively,” said Dr. Hagop Mekhjian, chief medical officer at OSU. “We need to find ways to reduce this.”
He said OSU’s readmission rates mirror national averages of 19.9 percent for heart attack, 24 percent for congestive heart failure and 18.3 percent for pneumonia.
Researchers say reducing readmissions can be as simple as taking time to explain discharge instructions, making an appointment with a family doctor and checking on the patient a few days after discharge.
“They go home and they’re confused about medications or they don’t have a good understanding of what a low-salt diet is,” said Dr. Thomas Archer, chief of heart-failure services at Mount Carmel Health System.
Many hospitals have heart-failure clinics for follow-up care. Mount Carmel’s readmission rate at these clinics is 4.5 percent, compared with 19 percent for its other heart-failure patients.
National reports such as Dartmouth Atlas’ let hospitals compare readmissions and try to improve, said Dr. Amy Imm, vice president of safety and quality at Riverside Methodist Hospital.
“A lot of times, we don’t know that people in different areas or different communities are performing better than we have,” she said. Riverside’s readmission of heart-failure patients is 14.5 percent, 10 points below the U.S. average.
The Ohio Hospital Association surveyed its members a few years ago, and the issue was a top concern.
“They cited that if we improved, we could save $162 million,” said Christina Williams, manager of patient safety at the association. “That was a pretty compelling opportunity for savings, and we could make care safer in Ohio.”
Hospitals should include patients and families in making improvements, patient advocates say.
“You can’t fix these problems without the patient perspective,” said Cathy Levine, executive director of the Universal Health Care Action Network of Ohio.