Medicare Reform: Denying payment for 30 day re-admissions

Connected Health: Expanding its Role to Prevent 30-day Hospital Readmissions

Friday, August 22, 2008 | Allison McDonough, MD

Dr McDonough makes the following Points:

• "Connected health can contribute significantly to preventing such readmissions by improving monitoring of patients after discharge."
• "May provide additional benefit by assisting with access to timely ambulatory care for high risk patients."
• "There is ample room for improvement in 30 day readmission rates."

• "In 2005, an average of 18% of patients were readmitted within 30 days of their hospital discharge, with a range of 14% at the 10th percentile to 21% at the 90th percentile (Commonwealth Fund National Scorecard on U.S. health system performance, 2008)."
  
• "Medicare estimates that 13% of these readmissions were “potentially avoidable,” based on the IPPS rule, with major areas of concern including poor communication with patients at discharge, especially around medications, and inadequate post hospital discharge monitoring."
• "Prevention of these avoidable readmissions could save Medicare about $12 billion per year. (Report on Medicare Compliance, Volume 17, Number 24, June 30, 2008)"

• "Post Hospital Discharge Monitoring: Remote daily measurement of vital signs and symptoms in the heart failure population has shown great promise already in reducing readmissions, through improved monitoring as well as patient education."
  
• "IT platforms which facilitate interactions with Primary Care Providers will enhance the effectiveness and efficiency of telemonitoring."
  
• "These interactions may also improve patients’ access to timely ambulatory care, avoiding Emergency Department visits and readmissions."

Great comments made by some readers:

"I would like to also suggest hospital/physician referral's to Skilled Nursing Facilities. Many people still have the idea that a "Nursing Home" is the end of the road of life, however this is no. Most SNF's can handle much higher levels of care post-acute and most offer wonderful rehab programs and all disciplines (PT, ST, OT). It would be nice to develop a "circle" of care. From Hospital to SNF and then home with home health. This would really help deter the emergency room visits and the costs asscoiated with such visits. Also, a way to educate about the Medicare 30 day window, post hospital stay, for patients and the hospital staff would be very beneficial. Most of the hospital case managers and ER staff are not aware of this benefit."
Posted by: Robin Davis



Comments by the Author: Allison McDonough, MD

• "There is clearly a vital role for the visiting nurse in caring for our sickest patients. SNF and Rehab facilities are also an essential part of the continuum of care. However, as you know, many very sick or complicated patients are still not homebound, and do not qualify for VNA services. I see connected health as one way to fill this gap."
• "...dangers patients face in periods of transition, e.g. hospital or SNF to home."
  
• "Research from Kaiser found that >90% of hospital discharge medication lists contained errors (such as duplicative medication classes, interactions, inappropriate dosing)."
  
• "Patients often feel, and sometimes are, abandoned."
  
• "Economic incentives to discharge early mean that patients are frequently sent home while they are still fairly ill."
  
• "we need to embrace the patient and guide them through the entire continuum of their care"