Search our articles
Hospital owners and administrators are screaming. Congress is considering legislation that cuts Medicare reimbursement for hospitals re-admitting patients within 30 days of being discharged for a particular diagnosis. I realize that hospitals have the responsibility of care, however in my opinion equal responsibility rests with the patient to make sure they are not a revolving door back to the hospital. Fining a hospital for an issue for which they have only partial control isn't fair. Why not fine the hospital and the patient equally by reducing reimbursements for related care? The current administration with its excessive spending fails to realize that reduced reimbursements to hospitals will only increase cost shifting to other parts of health care, for example to individual insurance plans, which is a separate issue under controversy.
Statistics from CMS indicate that unplanned re-admissions cost the Medicare program $17.4 billion in 2004 and that 50% of these readmissions were preventable. 1 How about working to reduce these costs by offering patient education and some cost shifting to patients?
Reasons cited by a study from the Health Policy Research Program of the JDC Brookdale Institute for returning to the hospital were: poor resolution of the main problem for the admission and inadequate post discharge care.2 What does this really mean? Communication between doctors and patients is poor in part because hospitalized patients are under stress and explanations easily are missed. Doctors also do not speak in terms that patients understand and patients do not ask for simple explanations. Follow up care is another gray area. Most patients leave the hospital and do not see their primary care physician within the recommended time frame or at all. The primary care physician is the doctor who knows them best and likely has no idea they were even hospitalized.
My older clients refuse home health care for physical and occupational therapy or skilled nursing because "there are just too many people coming to the house". Others receive prescriptions to treat conditions related to the hospitalization and never have them filled or just don't take the medications because "I already take enough pills". With all of this in mind, it's no wonder hospital readmissions are high.
Hospital discharge planners have the goal of sending patients home or to rehabilitation communities. They have a high case load and the time they have available to spend per patient is limited. Perhaps there is a dual solution. The first to increase available time discharge planners spend with patients to allow education and prevention. I don't know many individuals who want to go to the hospital yet can't wait for a return trip. If the reasons for readmission were made clearer to patients, and they were responsible for associated costs of returning to the hospital this might increase awareness that patients DO hold responsibility for their own care post hospitalization.
2. Health Policy Research Program, JDC Brookdale Institute, Jerusalem, Israel. This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Copyright 2011 Pamela D. Wilson, All Rights Reserved.
For more services available visit Guardianship, Financial Power of Attorney, Medical Power of Attorney, Personal Representative, Case Manager or Care Navigator and Move Manager Services.
Return to The Care Navigator Home Page.