Education, collaboration can help reduce readmission rates

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Did you know that 90 percent of patients return to their homes after hospitalization, yet one in five Medicare beneficiaries is readmitted within 30 days?

According to an article in a 2009 issue of New England Journal of Medicine, highlighting the costs and health impact of rehospitalization, the cost to Medicare at that time was $17.4 billion (yes, with a "B").

Since 2010, statistics are kept on every hospital. Readmissions within the first 30 days greater than 10 percent will subject the hospital to substantial penalties. Penalties began in 2013 for readmissions of 10 percent or greater from the previous three years - 2010-2012.

The penalty for the first occurrence is 1 percent of the hospitals' total Medicare reimbursement, 2 percent for the second occurrence, and a maximum of 3 percent beginning with the third.

To reduce Medicare expenditures, there have been many changes nationally regarding readmissions.

The patient, whether medical or surgical, is now required to have a face-to-face visit with their primary care physician within 30 days after hospitalization. If this does not occur, Medicare might not pay for treatment the patient has received.

Medicare has begun to carefully monitor physicians, home health care agencies and skilled nursing homes. Is there a possibility they might monitor the individual patient's compliance with their plan of care?

Some suggestions to prevent or reduce readmissions include:

  • During the hospital discharge process, better educate patients and assure their understanding of discharge orders, what medicines to take and when and which to stop; determine the level of support at home and provide resources for assistance available in the community.
  • Help hospitals better understand their comparative performance on readmissions by providing them readmission data for their patients, including those who were re-hospitalized elsewhere.
  • Collaboration between physicians and hospitals to ensure patients get follow-up care
  • Follow-up care from a primary care doctor as well as a surgeon for surgery patients
  • Collaboration between hospitals and agencies providing non-medical assistance in the home to monitor medication compliance, address home safety and prevent falls

The role of non-medical care in reducing the number of readmissions is a critical link in preventing readmissions and keeping the patient safe.

The importance of providing medication reminders, good nutrition and hydration, assistance with personal care, home safety checks, monitoring signs and symptoms to prevent falls and transportation to doctor appointments cannot be understated.

Bonded and insured caregivers, employees of licensed home care agencies, are trained to note and report changes in the person's status to their supervisors.

In addition, some caregivers provide respite for family members who may be exhausted after their loved one's hospital stay.

Rachel Carson is the owner of the Home Instead Senior Care franchise serving the Lowcountry since 1997.

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