Readmission and the $ Billion Question

1 in 5 Americans over the age of 65 are re-admitted to hospitals they just left within 30 days.  Why?

Well, that’s the $ Billion question.  26 Billion to be exact and Medicare estimates that 70% of those re-hospitalizations are unnecessary.   Consider that 10,000 more Americans will turn age 65 every day for the next twenty years.   It begs the questions why so many and why not fix it?

The biggest problem of fixing it is that readmissions are unpredictable and caused by many different reasons.  Preventing them requires patient intelligence after the patient leaves the hospital.  The systems designed to monitor patients in the home are old and expensive, making them cost-prohibitive to monitor all but those patients who are the most ill.   Surprisingly, it’s not those who are the most ill that are returning to the hospital the most often.  Care providers already have their eyes on the top 20% and/or those patients are discharged into facilities where they can be appropriately cared for.  It’s the 80% that is what is getting us.  So, to be effective, a hospital Discharge Re-Admission Reduction Program must be practical enough to apply to a broad population.

Many things can happen on the road to recovery.  A patient can receive new medications while in the hospital that interact with ones they are already taking.   The dosage of those new medications may also need to be recalculated or changed to a different one.   Maybe they cause vertigo resulting in a fall, or seizures, or lethargy, or instability, or…..  A common treatment plan for one of the most pervasive hospitalizations (heart failure) is a change in diet which could easily and dramatically cause a condition like diabetes to spin out of control.   A hip or knee replacement comes with changes to activity levels which can throw off medications, habits, and the delicate balance of wellness for some of our aged population.  And then, there are the more obvious reasons such as:  An infection after surgery.  A patient didn’t really understand all the instructions they were given when they went home and couldn’t comply.  Maybe there were no helpers in the home or maybe the person hospitalized does double duty as a care giver to another loved one and simply can’t recover with those demanding tasks.   So, to be effective, hospitals planning a successful Discharge Re-Admission Reduction Program must find a solution with sensitivity to an extremely broad variety of risk.

Fewer than 30% of the patients readmitted to the hospital do so under the same primary reason they were admitted in the first place.   Less than 30%, and that highlights the problem.  There’s no “one thing” to fix.   Hospitals planning a successful Discharge Re-Admission Reduction Program should be thinking about a solution that takes them closer to the patient post-discharge so they can monitor an on-going recovery and intervene when necessary.  In this manner, their efforts are directed at the right patients at the right time to ensure the right result.  But – they’d have to be able to do it for less than the $70 to $90 those old fashioned vendors are getting now.