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Facilities Get Creative to Reduce Hospital Readmissions

Cheryl Clark, for HealthLeaders Media, September 15, 2009

Comedian Tracey Ullman always closed her show by telling her audience: "Go Home." But if she were a hospital provider discharging her patients, she might add, "And we're going to do everything possible to keep you there."

As federal payers consider reducing or eliminating payments to hospitals if their patients must return for care in 30 or 60 days, California researcher Jan Eldred went looking for programs with creative transition solutions, so discharged patients can remain safely out of the hospital.

She found nine, from Boston to San Diego, and chronicled their success in "Homeward Bound: Nine Patient-Centered Programs Cut Readmissions."

The nine projects include:

  1. Colorado Foundation for Medical Care and Partners in North Denver
  2. Visiting Nurse Service of New York in New York City
  3. Boston Medical Centers for Disease Control and Prevention.
  4. St. Luke's Hospital in Cedar Rapids, IA
  5. Summa Health System in Akron, OH
  6. John Muir Health in Walnut Creek and Concord, CA
  7. HealthCare Partners Medical Group in Torrance, CA
  8. Sharp Rees-Stealy Medical Group in San Diego, CA
  9. Blue Shield of California

"Hospital readmissions can be significantly reduced using straightforward strategies that are inexpensive compared to hospital care," says the report. According to findings from some of the demonstration projects she included, up to half of all readmissions can be prevented.

The report was published by the California HealthCare Foundation and was written by Susan Baird Kanaan.

"New Medicare rules are coming, and everyone knows they're coming," which will reduce payments to hospitals whose patients must be readmitted within 30 or 60 days, acknowledges Eldred, the foundation's senior program officer who selected the nine programs from about 20 innovative health system strategies.

"We want organizations to know that there are health systems out there that have figured out how to do this already, and that there are things they know do work. They don't have to come up with something from scratch.

"That's the premise on which this report was prepared. We want organizations to know that there are programs that have figured how to do this, to keep patients from having to return to the hospital," Eldred says.

Eldred's report listed four stages of care that allow for effective intervention to reduce readmission:

  • Preparation for discharge, a process that can start even as they are being admitted, to make sure hospital staff is aware of the home environment.
  • Hand-off to the outpatient physician.
  • Medication reconciliation to make sure new prescriptions are filled and that patients are not falling back on their old medication routines.
  • Home visit and/or phone call, daily or weekly for the first 30 days.

Some of the innovative programs were launched as long as four years ago by organizations grappling with capitated rates in their health plans while others tackled the problem as an experiment. In all cases, however, leaders said the most important goal was to improve care.

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