Did you or someone you know have to go back to the hospital within a month of being discharged? You're not alone. Hospital readmissions are a serious problem, especially for those over 65. The Institute for Healthcare Improvement says that no more than 5% of seniors should be readmitted within a month of discharge. But the reality is that 20% of Medicare patients return to the hospital and 75% of those are considered preventable. This amounts to $17.4 billion wasted every year!
Why? People go back to the hospital because they have uncontrolled pain, an infection, a blood clot or recurrence of their original problem. Sometimes they didn't fully understand the discharge instructions or couldn't follow them. Maybe they couldn't afford the discharge medications. Sometimes they're sent to a facility that doesn't meet their needs. They're all common problems.
Why don't hospitals get it right the first time? For one thing, there's no incentive for them to do so. In fact, the more times you go back, the more money they make. Now I'm not suggesting this is on purpose, they just don't put enough time and money into discharge planning. For the most part, when you're sent home (or to another facility), you're no longer their responsibility. (Does that mean they stop caring? Well, yeah it does.)
Hospitals don't put enough effort into teaching you how to care for yourself, when to resume what activities, medication side-effects to watch for and how to get answers to your questions. Most of the time the computer systems between the hospital and your doctor are incompatible. Moreover, there are no consequences if they don't send the records before your post-hospital visit. Only 12-34% of doctors actually have their patients' hospital records before their follow-up. Even then they frequently lack test results, discharge meds and follow-up plans. Of course it's not considered "professional" for your doctor to tell you this, so he makes do with what he has, resulting in care that is less than optimal.
This issue is beginning to be addressed at some hospitals, but not out of a sense of duty. Medicare refuses to pay for readmission for certain diseases and the list is growing. This means that the hospital "eats" the cost for those readmissions. Since they don't want to lose money, they are hiring people to coordinate the discharge process. These are people who can see the big picture, what things look like from your perspective. They will have the time to coordinate between facilities, see that all of your questions get answered and that you know how to take care of yourself, follow up on you after you go home and manage your medical needs.
Hopefully, we we'll see this trend continue. This is what patient-focused care is all about.
I'm a Patient Advocate and I'm here to help.
(Dale Alexander holds a Certificate in Patient Advocacy from UCLA, a Master's degree in Medical Humanities from the University of Texas and has thirty years of experience in clinical healthcare, education and management. She may be reached at dale5657@gmail.com or 707.319.5856.)
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