And Don`t Come Back!

The Affordable Care Act (ACA) establishes programs to reduce hospital readmissions. It’s not hard to understand why. Recent data from the Centers for Medicare and Medicaid Services (CMS) revealed 30-day hospital readmission rates of 25% for those with heart failure hospitalizations; 20% for those hospitalized for AMI; and 18% for those in for pneumonia. The same data revealed the average age of the readmitted patient is 80, and most readmissions occur within the first 15 days. This is a unique population with specific needs.

Hospitals today have sophisticated discharge processes. We have discharge planners who coordinate clinical, social and support services, and sequentially move each patient through a fine-tuned discharge machine. We have technology-driven solutions with multimedia presentations in different languages. We hold educational programs for patients and families to learn about their diseases and not only how to treat them, but how to change their lifestyles to continue improving. We have support groups, transitional care institutions and in some cases home health. The reality is that some patients who are move through these well-organized programs still end up being readmitted.

This isn’t just a hospital problem, although the ACA is holding them responsible. There are programs whose main focus is readmission prevention, but reimbursement for such programs leaves most needing more. In addition, the characteristics of those who end up being readmitted differ from community to community. Successful systems require providers at different levels of care working collaboratively with a single focus: the patient.

We have to develop programs that use data to identify trends, special populations and those who would benefit from a unique approach to their needs. We need to think outside the box. The processes we use to deliver care are often outdated, but education programs continue teach them. In most cases we fail to evaluate our own programs to see if they are meeting the needs we think they are.

A major theme of IHD in this issue and moving forward will be readmission prevention. There are many unique programs that are helping patients, populations and systems. No single individual or specialty of healthcare delivery is the cause or the solution. The problem of preventable readmissions will only improve if we all become an integrated healthcare delivery system. 

—Jeff Beeson, DO