MedicalResearch.com Interview with:
Dr. Andrew Auerbach MD
Professor of Medicine in Residence
Director of Research Division of Hospital Medicine
Jeffrey L. Schnipper, MD, MPH
Associate Physician, Brigham and Women’s Hospital
Associate Professor of Medicine, Harvard Medical School
Department of Medicine
Brigham and Women’s Hospital
MedicalResearch.com: What is the background for this study?
Response: The Affordable Care Act required the Department of Health and Human Services to establish a program to reduce what has been dubbed a “revolving door of re-hospitalizations.” Effective October 2012, 1 percent of every Medicare payment was deducted for a hospital that was determined to have excessive readmissions. This percentage has subsequently increased to up to 3 percent. Penalties apply to readmitted Medicare patients with some heart conditions, pneumonia, chronic lung disease, and hip and knee replacements.
Unfortunately, few data exist to guide us in determining how many readmissions are preventable, and in those cases how they might have been prevented.
MedicalResearch.com: What are the main findings?
Response: Our main findings were that 27 percent of readmissions were preventable, and that the most common contributors to readmission were being discharged too soon, poor coordination between inpatient and outpatient care providers, particularly in the Emergency Departments and in arranging post acute care.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Improving communication and confirmation of care plans between patients, acute care, and longitudinal care providers is a key aspect to reducing readmissions. These efforts should focus on understanding whether a patient is truly able to care for himself after discharge, whether the care offered is consistent with his wishes, and on developing systems which can keep patients out of the hospital yet able to access certain aspects of hospital care (such as a blood transfusion, or IV fluids).
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: The problems contributing to readmissions and care coordination gaps are complex and numerous, but our research gives researchers a prioritized list of potential targets to study. Particularly, ways to ensure patients are not discharged too soon, and ways to create ‘ideal’ systems which can more effectively provide acute care services in ways that are useful and and aligned with patients’ needs.
MedicalResearch.com: Is there anything else you would like to add?
Response: Only about a quarter of readmissions are preventable, and about half of preventable readmissions are due to factors that occur after discharge. It’s easy to complain about this, with the penalties only going to hospitals, but we can also be pragmatic. Hospitals need to work with outpatient providers to improve communication and jointly come up with comprehensive programs to keep patients safe after discharge. This requires investment, but it’s a better alternative than paying penalties.
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Dr. Andrew Auerbach MD (2016). Only about 25% of Hospital Readmissions are Preventable MedicalResearch.com