Many Medicare patients return soon after hospital discharge

[AlphaCentauri]

Source: Chicago Tribune

One in five Medicare patients are readmitted to the hospital within 30 days of being discharged – and one in three are back within 90 days – in large part because they lacked a primary care provider, according to a new national study released Wednesday.

More than half of the nonsurgical patients in the study had not seen a doctor prior to being re-hospitalized.

The study, published in this week's New England Journal of Medicine, put the cost of the readmissions at $17.4 billion, a significant amount of the $103 billion paid by Medicare to hospitals in 2004, the most recent year figures were available.

The five most common medical conditions requiring readmission were heart failure, pneumonia, chronic obstructive pulmonary disease, psychoses and gastrointestinal problems. The five most common surgical procedures were cardiac stent placement, major hip or knee surgery, vascular surgery, major bowel surgery and other hip or femur surgery.


Read more: http://www.chicagotribune.com/news/nationworld/chi-medicare_02-webapr02,0,6360786.story

[Barack_America]

1. Another related issue, not having nursing homes or rehabilitation home placements...

...requiring doctors to essentially send them off to fend for themselves.

Huge issue in medicine today.

[pinto]

2. Part of the problem seems coordination of care at discharge, and payment structures.

"These high rates may result, in part, from inadequate coordination of care and poor discharge planning, since half of the patients who were readmitted within 30 days had no ambulatory visit before the rehospitalization," wrote Dr. Arnold M. Epstein, in an editorial that accompanied the study. Epstein is chairman of the department of health policy and management at Harvard School of Public Health.

"Although some patients may have been in close contact with doctors by telephone, these figures still raise questions about transitions between hospital and ambulatory care and complement a substantial body of other evidence that shows suboptimal coordination of care at the time of discharge," Epstein wrote.

Williams said the current health financing system rewards hospitals for "doing things" instead of preventing them.

To help prevent rehospitalizations, he said health providers need to focus on preparing the patient and caregivers for the transition to home and on coordinating follow-up care with primary care physicians. Medicare and other insurers pay for readmissions except for those within 24 hours of discharge, which likely contributes to lack of the effort to decrease them, he said.

"We don't pay hospitals enough so that pharmacists, nurses and physicians can educate patients about their medications and treatment so they don't get readmitted," he said. "We need to shift from paying for quantity of care to paying for quality of care."

(from the same article)

[Traveling_Home]

3. Saying discharge planning is a problem is nothing new

I was an Administrator for a Home Health Agency in the late 80's and discharge planning sucked then.

Huge problems for patients and families. Somewhere along the line it seems that Social Workers stopped being able to focus on service coordination and had to become focused on insurance coordination.

[murielm99]

4. No kidding.

I was in the hospital in January with e. coli.

Someone from the business office was there to see me before the doctor was there.

I was taken in an air ambulance from a small hospital to a larger one. The larger hospital had a different Blue Cross plan, so the two plans had to converse endlessly before my bill was paid.

The hospital bill was paid, but they are still trying to figure out the air ambulance bill.

All of this made me very tired. I was sicker than I realized. It is a good thing my husband was around to help with it. I can't imagine how seniors or other people who are critically ill can cope with the bureaucracy.

Anyway, someone is going to pay for that damned helicopter ride, and it is not going to be me.