This week’s article in the Post Standard on hospital readmission, has created a lot of conversation, and a lot of internet postings. It is worthy of some comment.
Starting October 1, Medicare has instituted a program that penalizes hospitals for readmission of a patient within 30 days of discharge for patients with certain primary diagnoses like congestive heart failure, pneumonia, and acute myocardial infarction. The basic premise behind this program is that if hospitals do their job, patients will go home and not return, and if hospitals do a poor job, they should be penalized in their reimbursement. The article discussed how most of the hospitals in Central New York will be penalized from Medicare with the new program. In the data that was published, University Hospital fares quite well in comparison to other Central New York hospitals.
The long-term question is whether such a program, over time, improves care and reduces costs. This is a complex topic that all hospitals will struggle with.
Patients’ diseases don’t run in a straight line, or in an always predictable manner. There are improvements and relapse. The reasons for this are complex, and certainly partly, but not completely, related to the hospital care that they receive. The quality of social support, the ability to meet transportation needs to get to a follow-up appointment, the availability of follow-up care, the ability to purchase and remember to take medications, as well as patients’ personal behavior such as diet, exercise, and medication compliance, all impact whether a patient discharged from the hospital will return within the next 30 days. For any episode of care, the hospital generally receives the greatest portion of Medicare dollars. This is the rationale behind forcing hospitals to try their best to influence this myriad of other factors to prevent readmission.
So what is a hospital to do? First, and foremost, do the best to take care of patients. Resolve their medical and surgical issues to the best of our abilities during the admission. Then, it is important to coordinate a transition of care from the hospital environment to the out-patient environment and to home. Patients should leave the hospital knowing when and where their follow-up appointments will occur. Patients should leave the hospital knowing, without question, what their medications are and why they have been prescribed each medication. Patients should be educated about the things that may exacerbate their underlying chronic illnesses, and worsen their co-morbidities. As providers of care, we ought to help to ensure that our patients have a reasonable chance of complying with the medications, follow-up visits, and instructions that we provide. Only in this way, do we have a reasonable chance to assist patients in staying out of the hospital and being cared for in the out-patient environment.
While a 1% maximum penalty in the current program may not seem like much, for all the hospitals in Central New York, it is a significant amount of money. In addition, all of our hospitals have invested funds to build the infrastructure to complete the goals that I have stated above. In addition, the penalties will increase in future years.
The re-admission penalties are one of many ways that the federal government, and, in the future, private insurers will be attempting to influence the quality of care, and to reduce the cost of providing care. Quality care at lower costs is certainly a goal we can all agree to. Whether we agree with the mechanism or not, the penalty for re-admissions is here and everyone in our institution, both in-patient and out-patient, needs to pay attention to the rules. We need to think creatively for ways to ensure, that as patients leave our hospital, that we have not only provided the best care possible, but given them the best chance to maintain their health and reduce their chances that they will need to be admitted again. It is a challenge not only for us, but for our patients as well.