The gigantic perverse incentive is for hospitals to
avoid the initial admission of sick patients with multiple morbidities. Those are
the patients that have a better chance of being readmitted within 30 days.
It is also impossible to evaluate quality of medical
care using claims data. False conclusions will not be a true reflection on who
is at fault and should be blamed and penalized for the readmission.
It could be
that patients did not adhere to the discharge instructions.
report divided readmissions into two types, those affecting patients whose
first admission was for a surgical procedure and those affecting patients whose
first admission was for a medical condition such as congestive heart failure,
pneumonia, or heart attack.
The hospital with the lowest rate was NYU Langone Medical Center, with
The University of
Medicine and Dentistry in New Jersey (UMDNJ) had the highest surgical
readmission rate with 20.7%, and the Stony Brook University Medical Center on
Long Island, with 20.6%.
If this data is correct
academic institutions will not be in the mood to be penalized for taking care
of sick patients.
Other studies have shown
that there is only a 50-60% adherence rate by patients to prescribed treatment.
This lack of adherence can be a significant driver to readmission rates. There
is no data evaluating patients’ role and responsibilities in re-admission
What are patients’
responsibility for their care? If patients do not receive enough education to
avoid hospitalization they should demand the education.
If patients are not
interested in self-management of their disease they should tell their
If the patient is too sick
to learn to self-manage a family member should be involved.
Patients have responsibility
for their self management to avoid readmission is high!
Yet the government is quick
to blame hospitals and physicians for high re-admission rates without examining
all the facts.
Another factor not
evaluated in determining readmission rates is the pressure on the hospitals to discharge
doctors feel they are caught in a squeeze play ," the report says.
"Hospital administrators carefully monitor length of stay—they are eager
to send people home because the longer a patient stays, the less money they
make. Thus providers said that the prevailing pressure is to discharge
patients as early as possible" even if it's too soon.”
is the slippery slope the healthcare system is on. The data management is
faulty. The government is not evaluating all the complex variables resulting in
hospital readmissions. This defect leads to faulty decisions. Those decisions
lead to more complicated unintended consequences.
should be driving the healthcare system not the government. The government
should make the rules to level the playing field for all stakeholders.
government should defend the interests of patients.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.