The Problem with Hospital Readmission

Signed into law last year, the Patient Protection and Affordable Care Act (Affordable Care Act) and the Health Care and Education Reconciliation Act will result in major changes for Medicare beneficiaries. In addition to changes for patients, these reforms will justifiably force medical service providers to reconsider patient safety protocols or lose revenue.

In 2009, the New England Journal of Medicine (NEJM) published a study indicating that 20 percent of 12 million elderly patients were readmitted to hospitals after 30 days of release. The study offered many unsettling findings. For those Medicare beneficiaries discharged with a medical condition, the risk of readmission or death within the year due to an initial misdiagnosis or other hospital error was 67.1 percent. This was actually higher than the 53 percent risk of readmission or death for all patients released after a surgical procedure.

And there was more than a human cost to hospital readmissions. These re-hospitalizations cost the federal health insurance system more than $17 billion annually. While the NEJM researchers placed the number of avoidable readmissions at 40 percent, Congress' Medicare Payment Advisory Commission (MedPAC) had previously concluded that 75 percent of hospital readmissions were potentially preventable.

Deterring Readmissions With Penalties

With the need to improve Medicare's financial solvency and to put into practice improved health care delivery services, Congress loaded the Affordable Care Act with provisions to deter potentially preventable, costly hospital readmissions. Effective October 12, 2012, hospitals will be penalized if they exceed an estimated 30-day readmission rate for patients with heart attacks, pneumonia or heart failure.

In anticipation of the more stringent Medicare rules, some individual hospitals and state systems have taken steps to improve patient safety and reduce readmissions. The Better Outcomes for Older Adults through Safe Transitions initiative (Project BOOST) serves as one national program promoting readmission prevention. Another initiative, State Action on Avoidable Rehospitalizations (STAAR), a four-state project with 150 participating hospitals, is also underway.

Some of the hospitals participating in these initiatives include Piedmont Hospital (Atlanta, Georgia), Evergreen Hospital Medical Center (Kirkland Washington) and the University of California's San Francisco Medical Center. Each has shown significant success in its efforts to reduce "bounce backs," or 30-day readmissions. These facilities have incorporated pharmacist drug reviews, identification of high-risk patients, Patient PASS protocols, post-discharge appointment scheduling and 90-minute bedside counselling and follow-up examinations into their treatment plans.

In the absence of health care reform, reality dictates a change in health care service delivery and costs. As the result of reforming hospital culture, millions of elderly Americans could have healthier futures.