A study recently published in The New England Journal of Medicine shows that 20% of Medicare patients are readmitted to the hospital from which they were recently discharged within a month. That percentage jumps to 34 when looking at a three month time period. The data, representing Medicare claims collected between 2003 and 2004, show that more and more discharge is becoming a time at which it is crucial to have a good communication plan in place among caregivers and patients. What's more, the presence of a strong continuum of care can lead to lower rehospitalization rates.
"In order to address this issue, we are going to wind up addressing the most profound issues in healthcare today," says Stephen Jencks, MD, MPH, a lead author of the study and independent consultant in healthcare safety and quality. "Issues like a system which has become provider-centered rather than patient- and family-centered. If your concerns stop when the patient goes out the door of the hospital or start when the patient comes in the door of your office, you're not going to provide the care that's necessary to keep people from being rehospitalized."
Saying that rehospitalizations are costly is an understatement. In 2004, $17.4 billion was spent caring for patients readmitted to the hospital; Medicare paid hospitals $102.6 billion in total that year. Med Pac, a commission that advises Congress on Medicare policy, has recommended that instead of rewarding hospitals for the quantity of patients they see, hospitals should receive payment for providing the highest quality of care to patients—including whether their patients are readmitted with select conditions.
Some states are already performing far better than others in terms of rates of rehospitalization. The five states with the highest rates of rehospitalization have rates 45% higher than the 5 states with the lowest rates of rehospitalization. What this shows, is the degree to which the community at large is a player, or what Jencks describes as a two-way street, and not simply the fault of the hospital.
"The way to see this is as a community challenge—to get people, whether they are hospital CEOs, nursing home managers, mayors, or the directors of the health departments—to be thinking about how their role involves bringing people together," says Jencks. "For a hospital, it's a wonderful opportunity for them to take a leadership position which will ultimately benefit them."
So how can hospitals do their best to prevent readmissions?