$25 billion (annually) changes everything
Did you know that 19% of all Medicare patients entering the hospital will be back within 30 days, and 34% within 90 days, costing America $19B per year? In the private sector, tack on another $6B for readmission on key diseases including congestive heart failure, heart attack, and pneumonia, and you have $25B a year in spending.
But here's the change: starting with this fiscal year, as part of the Affordable Care Act of 2010, Medicare will start penalizing the bottom quartile of hospitals with the highest 30 day readmission rates-- and penalize them a lot! If a hospital finds themselves in the lowest quartile (risk adjusted for age of populations and other metrics), they will lose 1% of their total Medicare and Medicaid revenues--and that's just this year. The bar will rise. 1% may not sound like a lot, but considering that most hospitals barely break even it's a lot of money. For a thousand bed hospital that has 50% of patients on Medicare or Medicaid, that could be $5M per annum -- serious bucks. This is a risk transfer of money from the payers (Medicare and Medicaid -- or you) to the providers (the hospitals). They are going to be held accountable for the services they deliver. It's enough to have the CEOs and CMOs of every hospital worried.
Why? Well often, these hospital executives feel they can't control what happens when a patient leaves the hospital, so why should they be held accountable? Comments I have heard from very senior executives:
"I can't stop a patient if they eat Kentucky Fried Chicken on the way home from the hospital."
"Her husband won't stop smoking."
"I talk about exercise and it goes in one ear and out the other."
"They are so old it's not going to make a difference what they do."
Well, these are valid concerns, since personal responsibility has got to be part of the answer. But it's also shirking of responsibility on the part of the hospital. Study after study validate that there are important steps the hospital can and should take that when practiced consistently, reduce readmissions as much as 40%†
1. Expedite transmission of discharge summary to other healthcare professionals - Only 20% of the time does this happen in a timely fashion today, according to JAMA
2. Educate patients throughout stay - The current discharge process is on average 8 minutes. That's not enough time to educate the patients and their caregivers if someone is sick enough to land in the hospital with a heart attack
3. Confirm medication plan - Only 37% of patients can state their medications and their purpose, according to Mayo Clinic Proceedings
4. Assess understanding with teach back - This means "don't talk at us: and then ask, do you understand?" Make the information available, with Q& A during and after the hospital stay
5. Make follow-up appointments - Patients should never leave the hospital without their follow up appointments. Usually a hospital will only schedule those related to their facility. But a patient needs their physical therapist, their primary care physician and other appointments scheduled too
6. Provide written discharge plan - we suggest giving it to family members, PCPs, and professional caregivers as well. It takes a village.
7. Organize post-discharge services - Rides to hospitals, confirm pharmacies, telemetric equipment to be set up. It's all the hospital's responsibility.
8. Assess patient risk - We know that some people can understand and take care of themselves better than others. If a patient is high risk, match the care levels appropriately. Make sure a case manager or social worker is involved. Yes, it costs more, but not as much as rehospitalization.
At Axial, we believe this is the standard of care that every hospital should practice. We've developed software that will enable hospitals, patients, and family members to help reduce readmissions.
Don't we all want to get better and reduce costs? NO Excuses, please!
†Estimates based on Project RED (Re-engineered Discharge), Dr. Brian Jack et al, Boston University, and Project Boost (Better Outcomes for Older Adults Through Safe Transitions), Dr. Eric Coleman et al, Society of Hospital Medicine studies