Subscribe
Jobs
Cars
Real Estate
Apts
Classifieds
Shop
WASHINGTON – Talk about unnecessary misery: One in five Medicare patients winds up back in the hospital within a month – and even worse, so does one in four patients with heart failure.
A major push is under way around the country to cut rehospitalizations, in part by arming patients with simple steps to keep their recovery on track – like getting past harried receptionists for quicker follow-up doctor visits and reducing medication confusion.
Less than a year into Medicare-sponsored “Care Transitions” projects in 14 states, participating hospitals already are seeing readmissions start to inch down, said Dr. Barry Straube, chief medical officer of the Centers for Medicare & Medicaid Services.
One of those projects, in Baton Rouge, La., sends health coaches to five area hospitals to guide high-risk patients through discharge and check how they’re faring through that critical first month. Of the first 145 patients coached, only seven had to be rehospitalized.
The key: Support, so that weakened seniors don’t backslide merely because they couldn’t get a timely doctor’s appointment or had no ride to the drugstore to pick up a prescription, said coach DeeAnn Broussard with Louisiana Health Care Review, a quality-improvement company leading the project.
Consider her heart failure patient who sought a doctor’s appointment, saying he couldn’t sleep. The doctor is booked all month, and his receptionist doesn’t realize the man has heart failure and really was describing shortness of breath when he lay down due to worsening fluid buildup.
“He needs to say, ‘I can’t sleep because I can’t breathe,’ ” explains Broussard, teaching a phrase that cues receptionists to squeeze patients in. A quick drug change might get rid of that fluid and avert a rehospitalization.
“This generation tends to be very obedient and does not want to be pushy,” she said. “No, it’s your body, it’s your life, let’s be a little pushy. That’s what the doctors are there for.”
Rehospitalizations ought to be handled with the same urgency as an epidemic, said Dr. Harlan Krumholz of Yale University. He helped the American College of Cardiology begin a “Hospital to Home” program this fall, signing up hundreds of hospitals to share solutions with the goal of cutting heart patients’ readmissions by 20 percent within three years.
“Somehow this idea of one in four people landing back in the hospital in a month is treated as business as usual, that it’s part of being sick in America. It doesn’t have to be that way,” he said.
The top risks:
Medication problems. Patients on a dozen or more drugs forget which ones they’re supposed to toss when given new ones in the hospital, or they can’t afford the new ones or have no way to pick them up.
Not getting a follow-up doctor’s visit within a week of discharge. Waiting longer is proven to increase rehospitalization. Yet even if patients have a primary-care doctor, getting a rapid appointment can be tough.
Not realizing early signs of trouble and knowing what to do about them.
Rehospitalizations also are bad for taxpayers. They’re costing Medicare $17 billion a year, a recent study estimated.
Last summer, Medicare started posting hospital readmission rates for the three worst conditions – heart failure, heart attack and pneumonia – on its Web site as peer pressure for hospitals to improve.
And as part of either Congress’ pending overhaul of the health care system or its own regulations, Medicare eventually hopes to cut payments for rehospitalizations in ways that encourage better up-front care.
“Even the best hospitals have room for improvement,” said Straube, who hopes to expand the Care Transitions program to all states in a few years.
