Health Law Forces Changes to Reduce Hospitals Readmissions and One in Five Patients Leaves CA EDs Without Being Seen

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Wed Mar 9 17:24:50 PST 2011



February 22, 2011
Health Law Forces Changes To Reduce Hospitals Readmissions
Kaiser Health News
 
By Michelle Andrews

"Welcome back" are two words you'd really rather not hear at a hospital, especially if you've just been discharged. Yet one in five Medicare patients found themselves back in the hospital within 30 days of leaving it in 2003 and 2004, according to a recent study in the New England Journal of Medicine. Even more troubling is the possibility that three-quarters of those readmissions might have been prevented, as estimated in a 2007 report by the Medicare Payment Advisory Commission (MedPAC), an independent agency that advises Congress.

What gives? All too often, experts, say, the problems that send patients back to the hospital might have been avoided if there had been a better handoff from the hospital to the people responsible for the next phase in a patient's recovery, whether it's the patient himself and his family, a home health agency, a nursing home or a hospice. "We don't do a good job of coordinating care," says Patricia Rutherford, vice president at the Institute for Healthcare Improvement, which is directing a multi-state initiative to reduce rehospitalizations.

Discharged patients may be confused about their new medication regimen, for example, or they may not understand diet restrictions. Maybe they don't have transportation to a follow-up appointment; worse, they may not have an appointment scheduled at all. In fact, the New England Journal of Medicine study found that half of patients who were readmitted within 30 days hadn't visited a doctor since their discharge. "For very sick patients being discharged by hospitals, we think that's way too late," says Rutherford.

Hospital readmissions aren't only bad for patients' health, they're expensive. MedPAC estimated that in 2005 readmissions cost the Medicare program $15 billion, $12 billion of which could have been avoided.

The health-care overhaul takes aim at the problem by penalizing hospitals with higher-than-expected readmission rates for Medicare patients who had been treated for heart failure, heart attack or pneumonia. Those hospitals could see their Medicare payments reduced by up to 1 percent beginning in October 2012, 2 percent the following year and 3 percent the next. The law expands in later years the list of conditions that can result in penalties.

The Department of Health and Human Services allows consumers to make side-by-side comparisons of hospitals’ readmission rates for heart failure, heart attack and pneumonia at hospitalcompare.hhs.gov.

"There's a very strong case to be made that if you want to change something as important as readmission, you've got to look at every lever you've got," says Stephen Jencks, a physician and lead author of the NEJM study. "Payment is a very important one, but by no means the only one."

A growing number of hospitals and health systems are already working on the readmissions problem with support from nonprofit groups and foundations.

To read the full article, click here.
 



March 7, 2011
One in five patients leaves California EDs without being seen

HealthDay

HealthDay reported that up to 20% of the patients who seek care at California hospital emergency departments "leave before being seen by anyone," according to a study in the Annals of Emergency Medicine. The researchers analyzed data from the California Office of Statewide Health Planning and Development on "9.2-million" ED visits at non-federally run California hospitals during 2007, also found that "patient income, as well as the affluence of the surrounding community" influenced how fast patients were seen. 

Specifically, for every $10,000 increase in average "household income, there was an associated drop in the number of patients who went unseen" by ED staff. The highest rates of unattended ED patients occurred at "teaching hospitals, county-owned hospitals and trauma centers, all of which experienced about double the rate of unseen patients as other facilities."
 
 


Anna Parks &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine
 
 
Contact us at: calaaem.news.service1 at gmail.com

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