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There’s no one solution to slow hospital readmission epidemic



Published: Mon, February 11, 2013 @ 12:00 a.m.

Associated Press

WASHINGTON

More than 1 million Americans wind up back in the hospital only weeks after they left for reasons that could have been prevented — a revolving door that for years has seemed impossible to slow.

Now Medicare has begun punishing hospitals with hefty fines if they have too many readmissions, and a top official says signs of improvement are beginning to emerge.

“We’re at a very promising moment,” Medicare deputy administrator Jonathan Blum told The Associated Press.

Nearly 1 in 5 Medicare patients is hospitalized again within a month of going home, and many of those return trips could have been avoided. But readmissions can happen at any age, not just with the over-65 crowd who are counted most closely.

Where you live makes a difference, according to new research that shows how much room for improvement there really is. In parts of Utah, your chances of being rehospitalized are much lower than in areas of New York or New Jersey, says a report being released this week from the Dartmouth Atlas of Health Care.

The AP teamed with the Robert Wood Johnson Foundation to explore, through the eyes of patients, the myriad roadblocks to recovery that make it so difficult to trim unneeded readmissions.

The hurdles start as patients walk out the door.

“Scared to go home,” is what Eric Davis, 51, remembers most as he left a Washington hospital, newly diagnosed with a dangerous lung disease. His instructions: Stop smoking. He didn’t know how to use his inhaler or if it was safe to exercise, until a second hospitalization weeks later.

There is no single solution. But what’s clear is that hospitals will have to reach well outside their own walls if they’re to make a dent in readmissions.

Otherwise a slew of at-home difficulties — confusion about what pills to take, no ride to the drugstore to fill prescriptions, not being able to get a post-hospital check-up in time to spot complications — will keep sending people back.

“This is a team sport,” says readmissions expert Dr. Eric Coleman of the University of Colorado in Denver. It requires “true communitywide engagement.”

Pushed by those Medicare penalties, hospitals are getting the message.

“It’s made hospitals go, ‘Oh my gosh, just because they’re outside my door doesn’t mean I’m done,’” said nurse practitioner Jayne Mitchell of Oregon Health & Science University, who heads a new program to reduce readmissions of patients with heart failure.

In a pilot test, her hospital is sending special telemedicine monitors home with certain high-risk patients so that nurses can make a quick daily check of how these patients are faring in that first critical month.

Too often, families don’t realize that many readmissions can be prevented.

Patients don’t have to be powerless, and the Robert Wood Johnson Foundation is beginning an effort called “Care About Your Care,” which offers consumers tips to guard against unnecessary readmissions.

“Everyone has to understand their role in improving the quality of care, including families,” said Dr. Risa Lavizzo-Mourey, the foundation’s president. “This could be a time when we turn the corner.”

Rehospitalizations are miserable for patients, and a huge cost — more than $17 billion a year in avoidable Medicare bills alone — for a nation struggling with the price of health care.

Make no mistake, not all readmissions are preventable. But many are, if patients are given the right information and outpatient support.

The new Dartmouth Atlas evaluated Medicare records for 2008 to 2010, the latest publicly available data, to check progress just before Medicare cracked down. In October, the government began fining more than 2,000 hospitals where too many patients with heart failure, pneumonia or a heart attack had to be readmitted in recent years.

Of seniors hospitalized for nonsurgical reasons, 15.9 percent were readmitted within a month in 2010, barely budging from 16.2 percent in 2008.


Comments

1whitesabbath(738 comments)posted 1 year, 5 months ago

Just like the Justice system keep that money rollin !!!

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2Cassie(88 comments)posted 1 year, 5 months ago

How about not rushing people out as soon as possible? One more day to give instructions and preparations for going home might help.

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3Ytownnative(1010 comments)posted 1 year, 5 months ago

obamacare will take care of all of this real soon

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4lumper(281 comments)posted 1 year, 5 months ago

2 reasons : 1), people are obese and stupid and 2), doctors are not as skilled/experienced as they need to be. hospitals want cheaper labor- i.e. less experienced docs.

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