Readmission Rates Revealed for 292 Worst Hospitals

Cheryl Clark, for HealthLeaders Media , September 1, 2011

Hospital Worker: "Do you have any idea how hard we work to get you the physician's discharge summary so it could come to you right along with the patient?"

SNF Worker: "I appreciate the effort. I really do, and it's useful in some ways, but you have to remember that we are a nursing facility. Physicians don't understand nursing, and no physician I've ever met writes a plausible story about what the nursing needs of the patients are, and what the care plan is."

A lot of the issue, too, has to do with what Jencks calls "resetting how much patients need to know about their disease, their treatment and their care, and how much families need to know, to a higher level of understanding and awareness."   Not only does the evidence suggest that when this happens, there are stunning differences between study groups and control groups, the hospitalization decreases extend to 60 and 90 days. "These community-based interventions are quite significant," he said.

Jencks says that hospitals should not sit around. "You're going to have to find approaches to deal with it, and you can't use a formula where it takes you three years to accumulate data just to know what's happening...You need to get cracking on this now."

>>Download the HospitalCompare database <<

* Note: CMS' downloadable data files cover a three-year period between July 1, 2007 and June 30, 2010, while the three-year measurement period the federal agency intends to use for penalty payments starts one year later, from July 1, 2008 to June 30, 2011. The 371-page rule governing the details for how those readmissions will be risk adjusted and penalties finally determined was published in the federal register Aug. 18.

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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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