Time flies. In just 21 months, the federal government will start penalizing hospitals with higher than expected readmission rates. And even though much about the regulations-to come remains unclear, clinicians along the care continuum are scrambling to get ready.
Or they should be. It's not just important for a hospital's bottom line. It's important for the patient.
We've been talking with some of the nation's experts on the subject, including Stephen F. Jencks, M.D., whose April, 2009 article in the New England Journal of Medicine set the tone for today's readmission prevention energy. His review of nearly 12 million beneficiaries discharged from hospitals between 2003 and 2004 found that nearly 21%, or one in five, were re-hospitalized within 30 days and 34% were readmitted within 90 days.
We also spoke with Amy Boutwell, MD, an internist at Newton-Wellesley Hospital in Newton, MA and Director of Health Policy Strategy for the Institute for Healthcare Improvement; Timothy Ferris, MD, medical director of the Massachusetts General Physicians Organization, and Estee Neuhirth, director of field studies at Kaiser Permanente in California.
Some of these strategies aren't yet proven to work in all settings, of course. And many are still in the demonstrations phase. But with national readmission rates as high one in five, and higher for certain diseases, many providers are trying anything that sounds plausible.
Here are some of the prevention strategies that these and other experts think might be worth a shot. Many involve—to a greater or lesser degree —following the patient out of the hospital, either in-person, electronically, or by phone, but others involve upside-down introspection and re-evaluation by providers along the care continuum.
1. Discharge Summaries
Dictate discharge summaries within 24 hours of discharge. Boutwell says that standard practice and policy at most hospitals is that discharge summaries are completed within 30 days of the discharge. "I was trained that the summary is a retrospective report of what happened in hospitalization. But what we need today is anticipatory guidance. Patients get discharged and go home. They can't fill their meds, insurance doesn't cover the med or they have questions. They're nervous and worried. They call their primary care provider, who didn't even know they were admitted.
Boutwell says that 30-day-discharge summary policies "might have sufficed in a time gone by. But that doesn't work anymore. Information needs to be available at the time of discharge. There's a growing recognition of this need, but staff bylaws haven't changed."