Two recent articles in The Journal of the American Medical Association (Jan. 23/30 issue) address the issue of readmissions to hospitals within 30 days of discharge. This is a huge issue as “pay for value” initiatives will be dinging hospitals financially, not to mention the public flogging hospitals will receive with these publicly reportable measures. To be fair, CMS is aware that 20% of patients discharged are readmitted within 30 days, and that is an incredible amount of money that the healthcare system is paying. One of the flaws, as pointed out in the articles, is that readmissions aren’t necessarily the “fault” of the hospital. Hey, but it is easy to punish the hospital; the regulators have been doing that for quite some time.
One of the articles demonstrates that the vast majority of readmissions are for reasons unrelated to the prior hospital stays. Duh! Isn’t this what physicians have been saying for years? Healthcare providers have long known there is a long list of factors contributing to readmissions, including but not limited to: lack of follow up care, patient non-compliance, access to care, cost of medications, cultural and social factors, information transmission, patient understanding of instructions, transitions of care, and, by the way – people who are hospitalized tend to have bodies that are not working at an optimal level.
So what should we do? Isn’t this what healthcare reform and patient-centered medical homes are trying to fix? It sure is! But are there things we can do now? The article does list nine strategies for physicians to try to decrease readmissions by improving the level of care. For that, I commend them. This is their list, but I bet you could add more.
- Keep organized information on patients’ medical issues, health goals, functional and psychological status, and behavioral and social issues.
- Consider patients’ acute, intermediate and long-term care goals.
- Be explicit with patients about social, economic, cultural and other factors that may impede their care.
- Use reader-friendly tools such as checklists and “red flag” lists to help patients and caregivers with self-management tasks.
- Use motivational interviewing and teach-to-goal methods to support self-care.
- Use pharmacy, patient and hospital discharge lists to ensure a fully reconciled and accurate medication list after discharge.
- Reinforce medication changes made in the hospital with patients, as appropriate.
- Use “pill cards” to help patients track drug changes.
- Allocate time to address care coordination tasks, using templates and checklists for specific tasks.