Want to know what's happening next in healthcare?

MedCityNews is the leading online news source for the business of innovation in healthcare.


“I read MedCity because it captures the pulse of what's going on in healthcare innovation, a go to source. I also like how MedCity supports women in digital health.”

Dr. Charlene Ngamwajasat, @doctorcharlene, Physician and techie


Sign up for our daily newsletter


Advice to hospitals: You are “big, rich, powerful” so fix readmissions

March 2, 2013 12:52 am by | 40 Comments

Hospital hospitals

GREENSBORO -- Reducing hospital readmissions -- particularly among the elderly -- requires improving coordination and communication, and engaging patients, according to speakers Friday at a statewide health-care summit.

More than 400 health officials attended the summit, which was sponsored by the N.C. Alliance for Effective Care Transitions.

The alliance is comprised of public and private stakeholders representing hospitals, long-term care, assisted living, home health, hospice, mental health, case management, insurance plans, community care networks and consumer advocacy groups.

The summit was conducted at a time when a spotlight has been placed on readmission rates as it relates to patient care and rising costs.

Advertisement

In North Carolina, about 190,000 Medicare beneficiaries are admitted to the hospital each year. Of those patients, about 16 percent, or 31,000, have at least one readmission within 30 days of being released.

Nationally, close to 2.6 million Medicare beneficiaries -- about one in five -- are readmitted to the hospital within 30 days. These readmissions cost an estimated $26 billion nationally.

In 2008, Medicare reported it paid more on average for treatments for readmitted patients than they did for their initial admission treatment in five categories -- major joint replacement, pneumonia, heart failure, renal failure and chronic obstructive pulmonary disease.

The Affordable Care Act authorizes Medicare to reduce payments to acute-care hospitals with excess readmissions through the federal Hospital Readmissions Reduction program.

"There is no magic bullet" when it comes to reducing readmission rates, said Pam Silberman, president and chief executive of the N.C. Institute of Medicine. "If we knew what to do in every community, we'd already done it.

"We believe we will be able to noticeably rein in health-care costs within five years because of what ACA provides in new opportunities to test new models of care delivery and payment models."

Speakers said that while their presentations were through Medicare and Medicaid filters, reducing readmission rates affects all demographics and ages, particularly as more people lose health insurance because of job layoffs. About 1.5 million North Carolinians, or 19 percent of the nonelderly population, lack health insurance.

"Being uninsured has a profound impact on health and financial well-being," Silberman said. "People who are uninsured are less likely to have a personal doctor, more likely to report delaying care due to costs, and more likely to end up in the hospital for preventable health problems or late stage cancer."

However, the increasing use of hospital services may be contributing more to high readmission rates than the severity of patients' conditions or the care they receive after being discharged, according to a December 2011 study by researchers at the Harvard School of Public Health.

Key elements of the ACA is that hospital are no longer paid for treatment of "hospital-acquired conditions" by Medicare, and hospitals with excessive readmission rates for pneumonia, heart failure and heart attacks will receive lower Medicare payments.

A total of 88 N.C. hospitals will receive lower Medicare payments in 2013, according to an October report by Kaiser Health News,

For example, because of its higher readmission performance, Wake Forest Baptist Medical Center faced reduced Medicare reimbursements of $730,000 to $980,000 for the fiscal year that ended Sept. 30, 2012. It was the largest penalty among the state's urban hospitals. Wake Forest Baptist has been cited in several studies in the past year as performing worse than the U.S. average when it comes to patient readmissions.

Wake Forest Baptist officials say the federal government's performance review doesn't fully take into account how many very sick Medicare patients from 20 counties end up there, often referred from other emergency rooms. Officials with Medicare and the foundations say their ratings and study account for that.

Stuart Altman, a professor of national health policy at Brandeis University, said he gets questions from hospital chief executives and chief financial officers asking "why are we getting penalized when we take care of the patient?"

"I tell them, 'you are big, rich and powerful, and you have the ability to resolve the problem and you will be part of the solution whether you like it or not.' "

Some summit participants said they are concerned about health-care consolidation putting too much power in the hands of the large not-for-profit systems. They said they are concerned about backlash from the hospitals for requesting that patients be readmitted since it now affects their Medicare reimbursement amounts.

"There are appropriate readmissions, such as related to different ailments or an unforeseen health event unrelated to the first admission," Altman said. "Hospitals are not penalized in those situations.

"However, there also are non-appropriate readmissions that can be benchmarked and compared with peers and the community."

Jennifer Cockerham, director of the chronic care program and quality management for Community Care of N.C., said one factor complicating readmissions within 30 days is that in 23 percent of the cases, the patient is not going back to the initial hospital. "That can lead to multiple records and diagnosis and tests that can be prevent with better coordination of electronic medical records," Cockerham said.

Most efforts to reduce readmission rates have focused on improving transitional care -- what happens to patients at discharge and shortly after they're released from the hospital.

For example, Forsyth and Wake Forest Baptist medical centers have formed a partnership aimed at enlisting local nonprofit organizations to help reduce readmission rates by at least 20 percent, hospital officials said.

"We know we have a three-day window to make sure patients have their proper medication, have doctor appointments set up and other appropriate post-hospital care," Cockerham said. "To make the most of that time requires accountability, relationships, coordinated care and communication."

[email protected]

(336) 727-7376 ___

Copyright 2014 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

By Craver, Richard

Visit website | More posts by Author

40 comments
HenryL
HenryL

I some parts I agree with you. I just know what I have experienced.  Having worked in home care as a RT I have seen that there are things that can be done at home rather than having the patient stay in the hospital, at a much lower cost.  Ventilator care is one of those things.  Rather than spending $5000 + in a day in the hospital, send the patient home where that is the cost per month. Much more cost effective and better for the patients health and pocket book.  I am not talking about sick patients but stable patients. I made a visit once to a patient who had just been released from the hospital, and should not have been, where she had been treated for pneumonia.  She was sweaty with fast shallow breaths and on 2 lpm her sats where in the 80's.  I called her MD and had her sent back to the hospital.   I currently live in Ecuador where the cost of seeing a MD is $35.  We do have insurance and that pays some of the cost.  When my mum was alive living with us here we had to get prednisone for her and was able to do it without and Rx.  The cost for a short course was about $20 I believe.  What would that cost have been in the states?  I remember seeing an ad in an early 1960's magazine saying "Are you prepared for a hospital stay of $150 a day?"  Unfortunately, the US government and insurances are now messing with the very entities who could help keep cost down, the DME and home nursing companies.  

JamesCurran62
JamesCurran62

To Henry:

Hate to disagree with you but insurance companies will not pay the hospitals for what they call extended stays,when the companies think they can do it at home.I was a nurse for 25 years and my sister handles the monetary side of the hospitals.You can deposit in the bank that it is only the insurance companies that are driving up the cost of being ill.why do you think the hospitals and outcare workers are being laid off,there is not enough money for them.  

Chessie
Chessie

@JamesCurran62 Of course I do not know where you were employed, but if you will read Time 3/4/2013 it is patently obvious that hospitals do have the money to hire enough staff, but they spend that money for the wrong things, such as purchasing land that they do not use or may not use for years to come, frequent  unneeded cosmetic changes and obscenely high salaries for their corporate elite. Staffing is not adequate to give the type of care needed with the high acuity found in patients today. We are living longer but the quality of our lives in not always better, 
We do have the best medical care in the world, but not for everyone, only for those who have the funds to pay for this care.


JamesCurran62
JamesCurran62

@Chessie @JamesCurran62  Chessie I live in Massachusettts and where I live a hospital system,Ma.Gen,Faulkner,Salem Hosp.,North Shore Childrens,in other words Partners Org.placed a full page ad,stating the obvious that the hospital elite get the big money,but contrary to popular opinion the hospitals do not have the money to buy land,nor pay for full time staff,they can only pay for per diem staff.I wish I could agree with you but the insurance companies give the money to the hospitals and not enough of it gets to pt. care.Why even when you go to see your PCP he can only spend 15 min. with you and 30 minutes for my yearly physical.In the past 74 yrs I have seen a downgrade in health care.I can even remember when Drs made house calls.

Chessie
Chessie

@JamesCurran62 @Chessie Sad but true, medical care has deteriorated over the years. I, too, remember doctors making house calls. 

In Western MA, a hospital group purchased land, ten years ago, and it is yet to be used.  The corporate elite get obscenely high salaries, and cosmetic changes have been made to existing facilities owned by this group. However, staffing is short even on units with high acuity. 

I cannot complain about the care given by my PCP. However, this hospital's umbrella company is buying as many private practices as it can so that they can be the only "show in town." In fact my daughter calls them the Medical Mafia. They are is not alone in this ploy as many hospital groups are doing the same thing. (Per your post) Unfortunately, these groups do not want to have any competition. Competition creates better care.

jaclocla3
jaclocla3

@JamesCurran62 The whole system has flaws.  The problem is that doctors and patients are no longer in control.  Government mandates, Medicare basically setting the prices for procedures, and insurance companies are all part of the problem.  ACA, Obamacare, makes these problems worse.

Here's a very good article that describes the multitude of problems faced and real solutions to bringing down medical costs, not artificially putting controls on the cost of insurance.  That's where the focus should have been.

My favorite quote is "Too much time and emphasis has been placed on

attempting to reduce the financing costs, while there has been

no focus on the cost of care. This is like trying to reduce the cost of

a car by spending 80 percent less on the tires, and still expecting

the car to drive safely and efficiently"

http://www.jpands.org/vol18no1/weber.pdf

HenryL
HenryL

As a home care Respiratory Therapist I have seen some patients who were sent home to early as well as many patients who just don't follow the routine given them that could keep them out of the hospital.  Unfortunately, the government is causing many durable medical equipment business to go out of business.  Nursing companies aren't receiving adequate reimbursement to even send out a nurse.  These companies with the Respiratory Therapist (RT) could be utilized at a fraction of the hospital cost, to assist and follow up with pulmonary patients.  I have worked with companies who have worked out a system where by asthmatics could be seen and taught in the home by a RT, keep the patient out of the hospital  and would save a bundle of money for the insurance company in the long run.  Unfortunately, the insurance company would say great, go ahead. We just don't want to pay for it.  So, it is not just one entity responsible for patients readmits.  It is the patient not following doctors order, hospitals releasing patients to early and follow up care not covered by insurance companies, including government insurance.  Hospitals and MD's are blamed, but in the end it is also the patients responsibility to take care of themselves and many don't.  I have seen it on the home care side. 

Jean
Jean

I wonder how many readmissions are a result of patients being kicked out of the hospital too soon becuase of limits on what insurance will pay re # of days in hospital.  While such limits can reduce unnecessary costs, they also cause some patients to be sent home or to a rehab facility before they are really ready to be realeased.

Chessie
Chessie

@Jean Jean, I am sorry to say, too many, way too many. The bottom line is what is important, not the doctors' expertise, not the expertise of nurses working on the various units in a hospital, but hospitals who want turnover and insurance company greed. In the future, when hospitals will not be reimbursed if a patient is readmitted with the same diagnosis within a given time, there may be some really good changes until then we will continue to see patients released, from the hospital setting, sicker and quicker and then being readmitted.

7citizen7
7citizen7

@Chessie Sorry to burst your bubble, but hospitals can neither cause a patient to be admitted nor dismissed--those orders come from the physician, either a PCP, an ER doctor or a clinic doctor--never a "hospital" authority!!!

7citizen7
7citizen7

Chessie, what is it with your love of Time Magazine??  That IS NOT a medical publication, nor is it written by a person that has an extensive medical background.  I have worked for doctors and in hospitals.  In the hospitals, I started out working with patients, then moved into the insurance part, then into the accounting part, so I have some knowledge of what I am talking about.  Socialized medicine has been talked about since I was a small child, and believe me, that was a long time ago.  The medical people (my dad was a PA before it had a title) have always said it would NOT be in the best interest of the patient nor the medical staff.  I grew up listening to doctors, nurses, lab techs, radiology techs, etc. talking about all of this.  It was not well thought of in the 1940s and it is still not a good idea.

 Yes, we need to fix our insurance coverages, but one policy for the entire USA is not good.  That is like saying everyone in the USA must drive a Ford pickup truck.  I am now retired so don't know for sure who is running things now, but back a few years ago, BCBS told the hospital how much they could charge and which tests they would cover--even the daily room rate was dictated by them.  After Medicare started, BCBS even set the amounts that could be charged to Medicare. 

Chessie
Chessie

@7citizen7 You may see a single payer system in your life time. More and more physicians support this. Check out PNHP (Physicians for a National Health Plan.) I heard from them every week. Doctors are seeing patients in their offices too late in their course of illness because they could not afford preventive care. Health care in this nation is much more expensive than in other nations and we have a poor outcome for all that money. There is greed in the insurance business and in the "hospital business." Doctors, for the most part are not overpaid, but insurance company CEO and hospital corporate elite are grossly overpaid.

jaclocla3
jaclocla3

@Chessie @7citizen7 If you ask any of your own doctors and doctors you meet, very few will say they support single payer.  We had one of the best systems in the country until ACA came along.  We needed a few adjustments and a better way to help the uninsured get insurance, but the system worked well.  If you are actually ill, socialized medicine is not a good thing.  Health insurance does not equate to health care.

As someone who has personally done imaging studies on dozens of Canadians because wait times are too long in Canada, I know from experience.  I've also had patients from the Middle East and different parts of Europe.  They come here because this is where all the advancements take place.  This is where the new drugs, procedures, therapies, etc are mostly developed.

Just look at breast cancer survival rates, wait times, infant mortality and other information in these 2 links.  The U.S. system comes out best:

http://www.medicalprogresstoday.com/2012/08/health-outcomes-united-states-the-leader.php

http://www.medicalprogresstoday.com/2012/08/health-outcomes-united-states-the-laggard-not-really.php

JamesCurran62
JamesCurran62 like.author.displayName 1 Like

@7citizen7 ,I do not know where you came from,however aa hospital chiefs and dr.and nurses,where I am from took out a full page ad stating that it is the insurance companies fault that the prices are too high.IE: two years ago I had an MRI,last year I had the same MRI with the same equipment and it cost $1,000.00 more because that is what the insurance company charged.There is no need to go further because if you look up the insurance companies in the dictionary,beside it you will see the defintion of it is greed.   

Scott
Scott

Ridiculous comment about hospitals being big and rich and powerful.  How about the ones laying off staff and cutting services?  What we need is more intelligent comments from people knowledgable about hospital operations and less from the peanut gallery imposing their misinformed notions.

Chessie
Chessie

Scott, it is precisely because hospitals, hospital chains and their umbrella companies are "rich and powerful" they can furlough, RIF, lay off, take you pick of synonyms, needed RNs, X-ray technicians, laboratory technicians, They put their excess money, and there is a lot of excess money, into cosmetic improvements, purchasing physician practices, obscenely high salaries and benefits for the corporate elite, as well as purchasing land that is now off the city tax rolls. This land may not be used for years in the future. Being a "non profit," does not mean that they do not have "profit" every single year. It is just  that they do not pay any of that profit to stock holders. Trust me hospitals and their umbrella companies are very rich and very powerful. There are many ways that hospitals make a sizable profit but that would take too much space.

If you get a chance to do so, please read Time Magazine, the March 4th issue. It is a lengthy article but well worth reading and this tome will elucidate how hospitals really do business. 

Unfortunately, as the article states, the uninsured patient, the person with the least amount of money pays the highest rate for all hospital services.There are still many uninsured among us. Many have lost insurance due to divorce or death of a spouse, and they have a 30 day waiting period before they can get on Commonwealth Care, which is the insurer for Massachusetts. Other states have other types of insurance, but again there is a waiting period, and much can go wrong in 30 days or more depending upon the insurance and the state.

I know that this will not happen in my lifetime but I would love to see a Single Payer type of health care, and I am not alone as many physicians and nurses are in agreement. 

andronetta
andronetta

As a former Case Manager, I can tell you that medication errors and late follow up visit to the MD and poor dietary choices are big drivers of readmissions. If all medications were labeled primarily with their generic name, we would have fewer drug overdoses at home. Most drugs have multiple brand name and discharge instructions often use brand names.

JamesCurran1
JamesCurran1

To jaclocia3;Ihate to contradict you but it is not the penalties,reimbursment from the government,or the noncompliant pt's who are at fault(i admit they are part) but 90% of the trouble is the insurance companies and the people in congress who grab money from the lobbyest  who are the blame,IE Lieberman the independent from Connecticut whose wife worked for one of the biggest insurance companies in the country and who was the loudest voice against the independent insurance company that was on Obama's program.If that was part of the ACA the insurance companies would be afraid of raising prices,if you can remember that far back the day that was shot down the prices went up from7 to 9% the very next day.Wake up people and put the blame were it belongs,on greedy insurance companies.

jaclocla3
jaclocla3

 @JamesCurran1 Sorry, but businesses have to make money to stay in business.  That's life.  There are ways we could have helped the small percentage of people get insurance if they wanted besides ruining the system for the other 90%.  Many of the people who are uninsured are eligible for Medicaid but haven't signed up yet.  Many others choose to go without.  Actually helping those who need it would have been better than punishing everyone with substandard care, long wait lines, and technology that will become outdated soon.  Ask anyone from a state with a large elderly population on Medicare how hard it is to find a doctor to take them.   Doctors and patients should be in charge, not the government. 

jaclocla3
jaclocla3

Hospitals and doctors have very little say in the matter and that's the problem.  Irrational penalties from the government, reduced reimbursements from the government, and patients who are noncompliant are the primary factors involved.  If people care so much about these problems, hospitals and doctors should have been at the table when Obama was ruining our medical health insurance and care.  Doctors and hospitals are on the front lines and could have been invaluable but were ignored.  Now we face more cutbacks, more penalties, more government control and less autonomy.  One size does not fit all.

Chessie
Chessie

 @jaclocla3 Actually, ACA, while not great is a good start. Unfortunately, the insurance companies are still part of the problem. I ask you to read Time Magazine, the March 4th edition. It is a long article, 36 pages, but well worth reading and quite an eye-opener.

Our president wanted, at the very least, a Public Option, but congress would not allow it. What we need is a Medicare for All type of health care. Medicare is NOT all government run, as private contractors are utilized.  8,500 are private contractors and 700 are government employees. For Profit Insurance companies spend ten times what it costs to administer each medical/surgical incident. Medicare costs $3.00 to administer, for profit insurance costs $30.00 for each medical/surgical incident. (see Time Magazine, 3/4/2013 edition.)

jaclocla3
jaclocla3

 @Chessie  Why do you think so many doctors don't take Medicare?  Why do more and more stop taking it every single day?  Medicare is a huge problem.  The government even had to force people into accepting it by denying people their Social Security money if they didn't sign up.

ACA is about the worst that could have been done.  Government interference has caused most of the problems we have in health care today.  Forcing insurance companies to cover "kids' up to age 26, to allow all pre-existing conditions without pentalty, and to cover every single type of care imaginable for every single person is asinine.  Old women and young single men don't need to pay for OB care.  People without kids don't need to pay for eye and dental care for children.

The only thing that will save us is allowing the market and individual choices to take over.

The only one greedy in this case is the federal government--their desire for control over our lives knows no boundaries.  It is impossible for the government to be omniscient.

Please wake up and stop blaming greedy businesses for all our ills.  In a few years, when you have to wait until you're already dead to be scheduled for cancer surgery, it will be too late. 

jaclocla3
jaclocla3

@Chessie @jaclocla3 Federal spending as % of GDP was 16.4% in the 1950's and today it is a whopping 25.5% of GDP. That's an increase.  FICA taxes are higher today.  Medicare tax didn't even exist in the 1950's.  In the 1950's nobody was exempt from federal taxes and today about 50% of the people pay no federal taxes.  

In 1900, tax freedom day was January 22. In 2011, it was not until April 22.  

As for the educational system, that went bad as soon as we allowed the federal gov't to take control over it.  Again, one size does not fit all.

We don't have a lack of taxation problem, we have a spending problem.  

"It is a paradoxical truth that tax rates are too high and tax revenues are too low and the soundest way to raise the revenues in the long run is to cut the rates now ... Cutting taxes now is not to incur a budget deficit, but to achieve the more prosperous, expanding economy which can bring a budget surplus." ~John F. Kennedy,

Chessie
Chessie

@jaclocla3 @Chessie Actually in the 50s spending was high! We build roads, dams, bridges and tunnels and all of this under a Republican president. Eisenhower brought the Autobahn idea over from Germany, and instituted here in the US. SS was in full effect, and had been since the 1930s. Medicare came later, but neither is an "entitlement" as you, I and others pay for these insurances through our payroll checks. No, there may not have been as many people on welfare rolls as there are today, but several things happened. Lack of jobs, lack of resources, (revenue in form of taxes) to rebuild our crumbling infrastructure, improve our schools and hire, not RIF teachers, hire more police and firefighters, not RIF them. We had a good educational system in the 40s and 50s and even 60s and 70s, but then Reagan hit the White House in 1981 and trickle down economics has been hammering the middle class ever since. Prices rise but incomes do not. Taxes have become lower for the ultra wealthy over the past 31 years. Look it up.

jaclocla3
jaclocla3

@Chessie @jaclocla3Also, a quick note about taxes. In 2007, according to the CBO, percentage of all federal taxes paid including income/payroll/corporate/excise taxes is as follows:

Lowest Quintile 0.8%  Second Quintile 4.4%  Third Quintile 9.2%  Fourth Quintile 16.5%  Fifth Quintile (highest) 68.9%

Top 10% pay 55%  Top 5% pay 44.3%  Top 1% pay 28.1%

If you want to go back to 1950's tax rates, including deductions for cars, homes, bar tabs,and more, that's fine as long as we go back to 1950's spending levels especially on entitlements.

jaclocla3
jaclocla3

@Chessie @jaclocla3 Nobody ever paid 91% in taxes due to all the deductions.  Look up Hauser's law. Tax revenue has remained almost flat no matter what the tax rates are, high or low. 

The free market is the only way to go. Yes, regulations are needed, but not control. SS and Medicare are broke.  SS was always a pyramid scheme. Having the gov't subsidize further only increases costs.  A college education is so expensive because of easy loans and grants.  Without interference, costs would not have risen so much.  By the way, the education bubble is about to burst.  Another bubble, like the housing bubble/crash, that was caused by government intrusion.

Look at the cost of laser eye surgery.  It's not covered by insurance or gov't mandates and has gone down dramatically over the years.

What we need is to restore the doctor-patient relationship and have patients realize the true costs of services, not just their cheap deductibles and co-pays.  

ACA still leaves millions uninsured, raised costs, forces many people into Medicaid and will destroy our system.  

We also need to allow people to purchase their own insurance by giving individuals the tax breaks to buy it that businesses now enjoy.  A voucher system would help low-income people to afford it.  That way, your insurance policy will follow you throughout life thus eliminating pre-existing conditions.

Chessie
Chessie

@jaclocla3 @Chessie The problem with the ACA, and this can be amended as time goes on, is that insurance companies are involved. With a Medicare for All, albeit, with a somewhat larger monthly payment that is taken from one's salary, no one would be uninsured and the insurance companies would be out of the picture. If we raised the cap on FICA to be higher than the $113,000. this would help both SS and Medicare, the latter of which would cover everyone.

Free market, and capitalism are great in theory and on paper  However it must be regulated to obviate the rampant greed that is destroying our nation. 

Please read the March 4th edition of Time Magazine.

If our nation would do what other nations do and subsidize post high school education, perhaps doctors and other professionals would not have the horrendous college loans that hamper they for years. Would this require higher taxes? Yes, it would. However, if you are old enough to recall the early 1950s the tax rate for the very wealthy was 91%.

JamesCurran1
JamesCurran1

Contrary to popular opinion the hospitals have no say in this manner.They are not as rich and powerful as most might think.The insurance companies tell the hospitals what to do with patients,what test to give them,how long to hold them in hospitals,etc.If a patient stays too long in a hospital,on the other hand they make more money if a patient is readmitted to the Hospitals.

 You if you care to,compare the health insurance companies to the unions,they have gotten too big for the people to handle and we have congress to blame for this.

Guest
Guest

Patients and PCPs need to work together with hospitals and home health agencies to make sure that every patient, when discharged, is ready for discharge and has the necessary help at home. Unfortunately, insurance companies don't like to pay for adequate home health care, so many people end up being readmitted.

 

On the other hand, there are those patients who won't take care of themselves at home by not taking their medications or doing what their physicians tell them to.  How to get through to them is the question.

 

Hospitals and hospital systems will manage with less money - they have in the past and will in the future.  Patients will be taken care of, as that is the reason we in the healthcare community have jobs and do what we do.  Perhaps if hospitals and hospital systems are really that concerned about losing money they could cut their upper management and physicians salaries to help out the patients? 

Chessie
Chessie

What often happens when hospitals have "to manage with less money," they cut staffing not  upper management. This negatively impacts patient care. Patients admitted often have co-morbidities, and complex medical/surgical issues, meaning that more, not less staff is required to even give patients adequate care. When mistakes happen, as they will, when units are under staffed, the nurses, not management responsible for the short staffing, get the blame. 

Gene Dameron
Gene Dameron

When will everyone learn, hospitals do not prevent readmissions, physicians do if they are willing to remain available to their patients 24/7 when they are hospitalized, when they are discharged to post acute and most important of all when they get home which is when the patient is most vulnerable to readmission.

Chessie
Chessie

 @Gene Dameron No doctor can be available 24/7. Do/did you work 24 hours a day, 7 days a week?  I know that when I was working, I did not, I am now a retired RN. Hospitals today usually employ hospitalists who who are physicians who attend patients while they are hospitalized and these doctors work on shifts. The patient may also be under the care of a surgeon if he/she needs surgery.  When the patient is discharged it is often too soon as the hospitalist is employed by the hospital and  the managers often push the hospitalist to discharge to free a bed for another patient. Sometimes even the surgeon is employed by the hospitals as hospitals or their umbrella companies are buying many physician practices to keep "everything under one roof."

After discharge from the hospital, he/she is under the care of his/her PCP. He/she may have a follow up visits with the surgeon, if he/she had surgery. Both hospitals and insurance companies are responsible for premature discharges, not doctors.

Chessie
Chessie

 @Gene Dameron What a superlative model. Your 7% readmission rate is to be admired. You are doing everything correctly and you and your staff are to be praised. 

Gene Dameron
Gene Dameron

The physician group that I represent has a unique way of dealing with this issue.

 

First and foremost the number of acute events that our physicians have to physically respond to are limited to events that threaten the patients status Quo.  In the skilled facility the nursing staff dictates when a patient will be seen by the physician, our rule, not theirs.  It is the nurse who is the front line and when the patients condition exceeds the nurses scope of care the physician responds.  That may be 15% of the events.

 

In the home it is a bit different. First the patient contacts our home health agency.  We do not own it, we just use certain ones because month anfter month they have demonstrated their ability to perform and be immediately accessable to our patients.

 

You understand better than most that when the RN shows up at the patients residence and applies his or her patient and medical skills they are sufficient 85% of the time to solve the problem and salve the patient's concerns.  However, when that 15% occurs the physician is called and responds to the patients residence.

Let's face it, sometimes the patient needs admission, possibly back to the nursing home or to the hospital.

 

The bottom line is that we are delivering the most appropriate care to the patient at the most critical time.  The patients are appreciative of the model and our readmission rate is 7%.  We must be doing something right.

 

Thank you for your comments,

 

Gene Dameron

Mantw Egglezopoulou
Mantw Egglezopoulou

To make the most of post-hospital care is required accountability, good medicines practices, coordinated and communication. The patients need to know how they manage their health. When doctors and patients communicate each other regularly (e.g. internet) maybe there is reducing in hospital readmissions

JamesCurran62
JamesCurran62

It is not all of the Dr's or hospitals fault that the dr's are always in a hurry.Blame those greedy bastards at the insurance companies,they are the cause of the hurry up shuffle.Did you know hospitals make more money if they kept the hospitals empty.Also the ER's would not be so full if everyone had health insurance.

Chessie
Chessie

Hospitals not only discharge patients too soon, but they are short staffed.The too rapid discharges will soon have to stop as in 2014, Medicare will not reimburse a hospital for a readmission of the same diagnosis if that readmission is too soon after discharge. Of course a hospital can get around this issue by not actually "admitting" the patient, but have patient stay in the emergency department for a lengthy period of time, treat the patient, and have the designation not under "admission," but designate the patient as an "observation" patient, an entirely different "billing code."

 

Hospital claim, "Non Profit" status,but much of their money goes to "Capital Improvements," these include, buying property, which is now off the tax rolls of the various communities, even though the hospital may not use this property until years in the future, building a new building , parking garage and cosmetic changes that do nothing for patient care, or safety. They spend countless other dollars to pay the inflated salaries of the corporate elite, and countless "middle management" employees." These "middle management" employees know that their jobs hang by a thread," as they must do the bidding of upper management and dare not advocate for the registered nurses, or ancillary personnel, on whom a hospital depends for patient care.  Those "middle management" employees have extremely  high salaries but if they do act as advocates for their staff, they quickly find that their positions have been taken by someone who will cooperate with upper management. If a registered nurse, often with an advance degree, leaves "middle management" she/he must start at the bottom of the pay scale if he/she decides to return to working in the clinical areas, even if she/he has been employed by that same facility for many years. I have know nurses with twenty five years of clinical expertise, taking a middle management position, advocated for the staff, and were told that they were replaced, and had to try to find a position in the clinical area of their expertise and accept the same salary as a new employee. These nurses, also, lost the "years of service" they had accrued prior to taking the middle management position. Except for a few choice hospitals, nurses and the other care givers are not treated well, while they are the backbone of the health care industry. A hospital could smoothly run without their CEOs for weeks on end, but they could not operate without the nurses and other ancillary personnel.

If new equipment is purchased by the hospital, for instance the da Vinci laparoscope, it is quickly with exorbitant charges to the patients, paid for in the first year.  However, that same piece of equipment will last for at least six years before an upgrade is purchased, making the last five years that the equipment is used, pure profit. Those same exorbitant charges are made, to patients, for the use of that da Vinci laparoscope in years five or six as was charged in the first year.

This, my friends, is why medical costs in this nation are so high. 

Hear the latest news first

Get our daily newsletter or follow us.

Advertisement