12 Ways to Reduce Hospital Readmissions

Cheryl Clark, for HealthLeaders Media , December 27, 2010

Time flies. In just 21 months, the federal government will start penalizing hospitals with higher than expected readmission rates.  And even though much about the regulations-to come remains unclear, clinicians along the care continuum are scrambling to get ready.

Or they should be.  It's not just important for a hospital's bottom line. It's important for the patient.

We've been talking with some of the nation's experts on the subject, including Stephen F. Jencks, M.D., whose April, 2009 article in the New England Journal of Medicine set the tone for today's readmission prevention energy. His review of nearly 12 million beneficiaries discharged from hospitals between 2003 and 2004 found that nearly 21%, or one in five, were re-hospitalized within 30 days and 34% were readmitted within 90 days.

We also spoke with Amy Boutwell, MD, an internist at Newton-Wellesley Hospital in Newton, MA and Director of Health Policy Strategy for the Institute for Healthcare Improvement; Timothy Ferris, MD, medical director of the Massachusetts General Physicians Organization, and Estee Neuhirth, director of field studies at Kaiser Permanente in California.

Some of these strategies aren't yet proven to work in all settings, of course. And many are still in the demonstrations phase. But with national readmission rates as high one in five, and higher for certain diseases, many providers are trying anything that sounds plausible.

Here are some of the prevention strategies that these and other experts think might be worth a shot. Many involve—to a greater or lesser degree —following the patient out of the hospital, either in-person, electronically, or by phone, but others involve upside-down introspection and re-evaluation by providers along the care continuum.

1. Discharge Summaries
Dictate discharge summaries within 24 hours of discharge. Boutwell says that standard practice and policy at most hospitals is that discharge summaries are completed within 30 days of the discharge. "I was trained that the summary is a retrospective report of what happened in hospitalization. But what we need today is anticipatory guidance. Patients get discharged and go home. They can't fill their meds, insurance doesn't cover the med or they have questions. They're nervous and worried. They call their primary care provider, who didn't even know they were admitted.

Boutwell says that 30-day-discharge summary policies "might have sufficed in a time gone by. But that doesn't work anymore. Information needs to be available at the time of discharge. There's a growing recognition of this need, but staff bylaws haven't changed."

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10 comments on "12 Ways to Reduce Hospital Readmissions"

Rick Bloemen (10/1/2012 at 11:52 AM)
I agree with Charlene Perrone and her comments that a big piece of the puzzle is during the discharge process. How much real information and true guidance are the families getting. Should they just be discharged to go home? Do they need in-home care to help monitor and administer care? Should they be sent to assisted living and if so, which one ? I have seen the practice over and over where a family is given "The Blue Book" and left to their own resources. And then we all wonder why there is a recurring readmission rate.In our business, we are a placement agency, we visit and rate the homes, work with in-home care agencies, meet and spend hours of time with the families doing assessments for care and budgets and then we tour the family to the different homes, to match the patient with the right care. Case managers do not have the time or resources to know which particular home would be the right choice. They do not visit each home and see the layouts for handicap accessability and function, diet control etc. I ask the question as did Charlene Parrone, that has an in-home care company, why not get out of the box and use other professionals to help? There are ways of screening out the non-legitimate companies. And I ask, what is better The system we have that is failing or to try a new approach? Or do we continue just handing out "The Blue Book" closing our eyes and hope that it works this time.

Charlene Perrone (8/2/2012 at 8:53 PM)
I find that there's something missing in our discussion regarding reducing hospital readmissions, and that's the non-medical home care component. Health Plans, hospitals, even physicians are looking for strategies to reduce readmission rates including hiring hospitalists, additional social workers, and nurses. But no-one is talking about the most cost-effective way to discharge patients appropriately and assist them in recuperating at home. Non-medical home care companies like mine have skilled, experienced caregivers who are well-versed in the discharge process, understand medications and dme, are able to monitor vital signs once the patient is home and under periodic home health care, and can support the patient every step of the way in his or her recuperation...at home. Home Instead Senior Care has even developed its own "hospital-to-home" evidence-based program called Returning Home, which is proven to have helped Medicare patients avoid hospital readmission within that critical 30-day period. The program includes a strategy for tracking patients so that hospitals and home health agencies can understand and improve the benefits of this vital collaboration. I realize that the low-income and minority populations are most at risk for hospital readmissions, and clearly that's a problem when it comes to non-medical home care, because right now the only way to cover our service is through private pay, long-term care insurance or veterans' benefits. That's why health care facilities and insurance plans need to be creative...and understand how important a piece of this collaborative puzzle we are. They need to figure out a way to commission or contract with companies like mine to assist their patients at discharge. As an example, a hospital or health plan might think of partnering with a legitimate company or group of companies like mine and paying for a certain number of hours with their patients to make sure the discharge papers are in order, that all dme is ordered, that a home health agency has been prescribed, and then to transport them, to make sure all meds are in place, to ensure they have adequate food and supplies, and to do follow-up to make sure the patient is following all discharge orders. Working together, we can reduce significantly the number of hospital readmissions; I know this for a fact. I just don't know if anyone in the health care industry is listening. C. Perrone

Janet Thurston MSN (1/21/2012 at 8:20 PM)
Everything written creates a safer, better experience for all patients. With this information now coming into realization, why is it so difficult to do? ie Pts go home with their meds understanding them, Dr follow up appts arranged. Pt questions answered. Why would a pt have to pay 100$ for a copy of their medical record? This is another shame. Dr to Dr / free Dr to Pt / fee




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