Something always brings me back to you…

Imagine that hospitals actually did everything they could to keep patients from turning right around, readmitted for conditions related to what they were treated for in the first place.  Lately this concept has gained interest as a means to improve quality and control costs.  While no doctor or nurse would be happy to see a patient return with problems that were just treated, some health systems have cancelled initiatives that have successfully prevented such occurences on account of losing money.

A WIHI presentation from the Institute for Healthcare Improvement (IHI) from October of 2010 (download an audio file and/or associated materials here or on iTunes) touches on the elephant in the room often associated with discussion of readmissions; the fact that  improving readmission rates may also result in lost revenue.  Listen to the WIHI to get a much more in-depth perspective on that problem than I can offer.  It seems to come down to balancing regulation and the goals of the organization to find ways to make up for any revenues lost from reducing readmissions.

How common and/or expensive are readmissions, anyway? Is it even worth focusing on this one issue in light of everything else going on in healthcare?  This study in the New England Journal of Medicine found the following, among other things:

• 19.6% of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days and 34.0% within 90 days
• 67.1% of medical patients and 51.5% of surgical patients were hospitalized or died within the first year
• 50.2% of patients readmitted within the 30 day period had no proof of a bill from a physician’s office in between discharge and readmission
• Among surgical readmissions within the 30 day period, 70.5% were rehospitalized for a medical condition
• The average hospital stay for a readmitted patient is 0.6 days longer than a patient in the same diagnostic group

With this data painting a small picture of the overall problem, we can move on to investigate a couple attempts to do something about it.  The STAAR (STate Action on Avoidable Readmissions) Initiative from The Commonwealth Fund and IHI uses grant funding to attack the organizational boundaries in four states (Massachusetts, Michigan, Ohio, and Washington).  It’s a pretty unique approach, seeing as patient readmissions are usually tackled within an organization – not a statewide effort.  You can learn more about the STAAR initiative here or on the WIHI presentation I mentioned earlier.

The Affordable Care Act has taken a few measures to improve the situation.  Starting October 1 of 2012, hospitals will be penalized for maintaining readmission rates higher than the expected level, with fees increasing in subsequent years.  Many believe that the emergence of Accountable Care Organizations (ACO’s) will bring about changes that will address readmission problems.  They definitely would help with the problem, integrated systems such as Geisinger (PA) and Kaiser Permanente that spread the responsibility of patient health across players in the same system have produced low readmission rates.  However,  no one really seems to know exactly what ACO’s are going to be or how the concept will evolve.  This article in Healthcare Executive discusses the issue of readmissions and a few concepts that can guide particularly health administrators in making changes to help their organizations adapt without going into an ACO approach.

It’s almost impossible to touch on all aspects of this issue in one blog post, but my intention was to guide readers to a few resources and points of discussion currently going on in the whole debate.  There’s a lot more that could have been said, but hopefully this post is useful in identifying some of the resources that are out there.