Readmission Rates Revealed for 292 Worst Hospitals

Cheryl Clark, for HealthLeaders Media , September 1, 2011

For example, in an Aug. 26 letter to employees and physicians, Barnes Jewish President Rich Liekweg responded to a prominent article in the St. Louis Post-Dispatch. He pledged to improve care transitions, and the hospital's public image. He blamed some of the reason for such high readmission scores on "socio-economic factors, such as limited access to primary care, not having a consistent medical home to help manage care, lack of transportation, [poor] literacy, and poverty."

However, Liekweg said in the letter, the hospital will try to do more to reduce avoidable readmissions within six months. It will open a post-discharge clinic for those at high risk for readmission; "to ensure they see a primary care physician within seven days at no cost to the patient," he said. And it will launch a program that will do the same for heart failure patients and is piloting a program to provide a low-cost, seven-day medication "starter pack" for low-income patients.

"Through these efforts, I believe we are on the right track to prevent what could be avoidable readmissions and bring our rates into line with national norms starting later this year, and certainly in 2012," Liekweg wrote.

Strategies to tackle readmission

I wondered if what Liekweg and others are doing will be enough. So I asked Stephen Jencks, MD, who some have dubbed the “father of readmission research" for his thoughts. Jencks, former director of the Quality Improvement Organization in the Office of Clinical Standards and Quality and CMS' chief scientist, is the author of a pivotal paper in the April 2009 New England Journal of Medicine that woke everyone up about the severity of the nation's hospital readmission problem.

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3 comments on "Readmission Rates Revealed for 292 Worst Hospitals"

Deb Fiscus (10/18/2011 at 6:44 AM)
I have always felt that readmission rate as a measure of success was blantantly unfair. A hospital can provide the best care and get the patient ready for homegoing and still the patient will be back because they have not followed the discharge instructions [INVALID]quit smoking,change diet patterns, exercise either because they are unwilling, unable or can't afford the changes. Our hospital provides nutrition counseling, ongoing support for diabetics, smoking cessation and community exercises that are free, but we still have over 50% of the county who are hypertensive, diabetic and/or morbidly obese. These are the people who are consistantly readmitted even with the best efforts of the hospital staff. They refuse to make the needed life changes to keep them out of the hospital and thus continue to be readmitted for the recurrent problems that could be alleviated by following the discharge instructions and availing themselves of the available community resources. They choose NOT to and there is no punishment for them, only for the hospital that continues to readmit them. I envision a list of "DO NOT admits for 30 days following discharge" in the hospital ERs in order to preserve the Medicare funding.

Mary Freebern (10/17/2011 at 8:33 AM)
I have worked as a nurse in both areas (acute care and long-term care). There is a huge difference in what kinds of information is required to give the patients the care they need. In acute care facilities the need is for the patient history, medications being taken, and the length of time the patient has suffered from the current symptoms. A long-term care facility needs to know what steps they can take to keep the patient healthy and what to watch for in the case of a re-occurrence of symptoms. These criteria are vastly different and require better communication between these facilities. Nurses at a long-term care facility need to be able to follow a defined care plan that will assist them in keeping their patients out of the hospital. Unfortunately, most acute care nurses don't know what kinds of information that the nurses at the long-term facility need to know. I feel that if the acute care nurses and the nurses that work in long-term care could get together and discuss the information that is needed by the long-term care nurses that the patient would definitely benefit. This could be in the form of a specific check sheet or a questionnaire that is used by each facility. In that way they could be certain that the after care provided by the accepting facility would be more conducive to assuring the patient gets the best possible care. This would greatly decrease the need for re-hospitalization. The main focus of each nurse is providing the best possible care for their patients.

Chris Zona (9/2/2011 at 9:37 AM)
when one looks at the scores they need to look at the population being severe. If these are end-stage patients with no resources, even the best care will result in readmission rates that are high. It is no surprise that even though well known hospitals which served these populations have the statistics. Until we have insurance that will pay for long-term care and more resources outside the hospital, these rates will not change substantially.




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