Wednesday, June 9, 2010
Talking about readmissions
I was among the pretty small crowd of attendees at the National Medicare Readmissions Summit in DC yesterday. (There may have been more people attending virtually, although I can't imagine the strength and caffeine required to spend 8 hours listening to talk about Medicare over the phone.)
Anyway, some of what I heard anyone who cares, or has ever heard of Eric Coleman (who got name-checked more than Obama at a DC cocktail party) probably already knows. "You've seen these statistics already, six times that I know of," said an afternoon speaker before reviewing the data about how frequently patients are readmitted.
But there were also a lot of interesting points made. A sampling:
Even when all the involved parties know that readmissions are a problem, there are hurdles that prevent them from effectively working together. For example, an Aetna program to reduce readmissions had to give up on the in-hospital part of their intervention because they couldn't get their providers credentialed at the hospitals.
A program involving Mt. Sinai and the visiting nurses of NY uses NPs as a transitional care provider between discharge and the first visit to a PCP. The NP has a collaborative practice agreement with the hospitalist and visits the patient within 48 hours of discharge to do things like medication reconciliation, making sure they've got a follow-up scheduled, evaluating need for other services. This program sounded pretty cool, but some of their successes point out how far there is to go: they got the delay between discharge and the first outpatient visit down from 30 days to 18.
Want to get your administration on-board with your quality improvement project, but know that they're not impressed with the prospect of reducing readmissions, since it may actually cost them money? Focus on the reductions in length of stay, suggested one attendee.
Another cost-saver: one speaker pointed out that care coordination not only improves transitions, but can also reduce defensive medicine. For example, if you know that a CT scan was done just last week, you won't order another one. Or if the emergency doc knows that the patient's visiting nurse can keep a close eye on him or her, the doc may be less likely to admit.
That leads to what one attendee described as the elephant in the room: how much of the problem with readmissions is an issue of clinical decision-making? Are physicians admitting patients who could reasonably be treated as outpatients? The meeting's speakers admitted that it was a good question, to which they don't have an answer.
Speaking of things which might sort of be doctors' fault, it was shocking how many of the readmission reduction projects involved some mechanism for getting patients around the person who answers the phone at a primary care office. In some cases, this involved teaching patients specific words to say to get an appointment, instead of being put off by a receptionist. Don't worry, I won't repeat any of them, lest the whole world learn some of the magic words.
Labels: readmissions
posted by Stacey Butterfield at
12:26 PM
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1 Comments:
One of the things that's paramount to reducing readmissions is enough PCP.
I have a number of patients who have come back to the hospital because they can't see their PCP for several months after discharge.Therefore if there were investigations that needed to be followed up as an outpt, that gets delayed and patients end up back in the hospital for something that could have been managed outside the hospital.
Lack of healthcare doesn't help either!
I work in a small underserved hospital and a good portion of the patients don't have insurance or have medicaid and therefore can't afford prescription medications leave alone PCP.The good samaritan clinics which are understaffed can not cater for every patient in good time.
I definately compliment Mt Sinai staff for trying to get a good transition, my take on this is that we have to deal with the root cause of fewer physicians, like the accelerated Family practitioners training programs.
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