Nearly 20 percent of hospitalizations of Medicare beneficiaries result in the readmission of patients within 30 days of leaving the hospital. This costs the Medicare program an annual $15 billion, according to the Medicare Payment Advisory Commission, or Medpac.
This is an area of focus in looking to reduce unnecessary costs in the Medicare program. To reach cost saving objectives, hospitals with high rates of readmission will be paid less if patients are readmitted to the hospital within 30 days of discharge.
To study this issue and initiate some solutions, the John A. Hartford Foundation provided a $1.4 million grant to the Society of Hospital Medicine, a national organization representing hospitalists and the practice of hospital medicine. Boost, Better Outcomes for Older adults through Safe Transitions, focuses on one main goal of improving the care of patients as they transition from the hospital to the home. Six hospitals began the project’s pilot program in September 2008, and the other 24, including Rush, joined in March after completing an application process proving adequate resources to support the program. Our local Morton Plant Hospital is one of the hospitals participating in this program. It is commendable to see those efforts being made, and very important in an area with a large senior population (and one of the fastest growing 85 and older populations), many of whom are geographically separated from family supports.
Many elderly patients seen in the hospital have a multitude of factors impacting their health and safety upon return home. Some readmissions will always occur, but perhaps this program will help identify some simple steps that can remedy gaps. For example, note this quote: “The most concerning fact of this study was that these patients who were rehospitalized, half of them never saw a doctor in the outpatient setting after the initial hospitalization,” said Dr. Williams, who mentors hospitals involved in Project Boost. Most of the experts involved agree care coordination is the missing link, which would enhance follow up and communication.
As a community based care coordination program that has been working with thousands of clients since 1998, we see the importance of this communication and resource allocation. Many times it is the "little things" in the process of discharge and time following hospitalization that can make all the difference. From transportation and meal services to ensuring someone has a full understanding of medication changes (and a way to get those medications) to some additional support or care while regaining strength for a few days, it often does not take a great amount of resources to enhance patient safety and well being. The disconnect between providers is a real issue. Imagine a confused (whether due to memory loss or medical issues) patient arriving at the hospital alone...with little history to report and no one to explain the person's past and current situation, let alone an idea of prior medications, diagnoses and supports. There is often a disconnect both going in to the hospital and coming back out, but also with coordination between community-based providers. I shudder to think of it every time I am there as care manager with a client, providing all that information...knowing the person in the next room may be that one who is alone.
Efforts to address this problem must be supported. We are talking with local providers and figuring out some ways to pull together to address these issues in our community. We have great medical and eldercare/aging resources in our community so we should really be able to have an impact...often it's only a matter of bringing these resources together and coming up with creative solutions. A number of years ago we did something similar with Falls Prevention, as a result of a discussion between Aging Wisely and EMS/Sunstar Ambulance. That coalition has done a # of innovative things and brought together parties that often had no collaboration prior.
As individuals, we can address this issue through advocacy for our loved ones and awareness of the process and gaps. Until we find ourselves in these situations, most of us have no idea how these systems work (and why would we?). Most patients and families are surprised by some aspect of what is available or not, what insurance provides, or what the processes are.
We recently did an article on the Top 10 surprises in healthcare and eldercare, and can email that to anyone interested in learning more.