I first began to think about the hospital readmission problem in 2008 (see: Addressing the Hospital Readmission Problem). In a subsequent note, I discussed one of the causes of premature discharges from the hospital: freeing up beds for new admissions (see: Hospital at Full Census; Surgery Patients Discharged Too Early?). Hospitals are currently being penalized for readmissions within a month after discharge on the basis that such patients were inadequately treated during their first hospital stay (see: Armed With Bigger Fines, Medicare To Punish 2,225 Hospitals For Excess Readmissions). As another twist on this story, some hospitals are experimenting with home monitoring post discharge in order to identify patients with complications so that they can be treater earlier and avoid another admissions (see: Partners HealthCare Integrates Home Monitoring Data into Hospital EHRs). Here's a passage from that note:
Pressure is building for hospitals to reduce the readmission rate for discharged patients.... A key element in any such program is adequate attention to patient and family education at the time of discharge....As of October 2012, CMS began penalizing hospitals for excess readmission rates, starting with those related to heart failure, acute myocardial infarction, and pneumonia. In Indiana alone, the readmission rate for hospitalized patients is between 16.8% and 19% across the state....
I recently came across an article that suggested an approach, certainly not novel, by which some hospitals are reducing patient readmissions -- "talking" to patients with chronic and complex diseases prior to discharge (see: To Prevent Repeat Hospitalizations, Talk To Patients). Here is an excerpt from it:
Kevin Wiehrs is a nurse in Savannah, Ga. But instead of giving patients shots or taking blood pressure readings, his job is mostly talking with patients like Susan Johnson. Kevin Wiehrs and Susan Johnson confer about what works and what doesn't in managing diabetes. Johnson, 63, is a retired restaurant cook who receives Medicare and Medicaid. She has diabetes, and has already met with her doctor. Afterward, Wiehrs spends another half-hour with Johnson, talking through her medication, exercise and diet.....He was hired to pay special attention to patients with poorly controlled chronic conditions like diabetes and heart disease.....Getting these patients to trust Wiehrs is an important part of the hospital's strategy for dealing with rising costs. Memorial is investing $500,000 a year in care coordination, in the belief that the program will save money in the long run and improve the quality of care....Because Georgia is not among the states that have chosen to expand Medicaid under the Affordable Care Act, the hospital is going to continue to give a lot of free care to people who have low income and are uninsured.... On top of that, Medicare is penalizing hospitals (via lower reimbursements) when patients have to be admitted repeatedly for some specific conditions. ....On a typical day, Wiehrs meets with three or four patients and calls people who have just been released from the hospital. He says patients end up trusting him.
As the article points out, an important element of any care coordination program is having conversations with patients prior to discharge. Nurses such as Kevin Wiehrs can also assess the patient's (and family members') understanding of a chronic disease like diabetes including the care that needs to be rendered in the home. It's interesting that Wiehrs meets with only three or four patients per day. These encounters are thus costly for the hospital but, obviously, not as expensive as the penalties that can be levied for readmissions.
To restate the obvious, some patients with a chronic disease may not adequately attend to it. The reasons for this inattention are numerous. They may feel overwhelmed, they may not understand the disease process, or they may have a fatalistic view of the disease. Whatever the cause of this inattention, sessions with a sympathetic and knowledgeable healthcare professional would seem to be a necessary step to remedy the problem.