Patients Returning to the Hospital: Who is Responsible?

What is the role of patients specific to healthcare prevention and education to avoid returning to the hospital after being sent home? This is a question few ask. Instead, hospitals are financially penalized for elderly who return within 30 days for certain medical conditions.

The Affordable Care Act implemented legislation under the title of “Re-hospitalization” that penalizes hospitals that re-admit patients within 30 days of discharge for a particular diagnosis.

I realize that hospitals have the responsibility of care. However in my opinion equal responsibility rests with patients to make sure their actions do not result in a revolving door and a return to the hospital. The problem is that patients lack education about healthcare prevention so they don’t know what actions to take to remain healthy and at home.

Who is Responsible for Patients Being Readmitted to the Hospital?

Fining a hospital for an issue for which they have only partial control has resulted in unintended consequences for the elderly. The government failed to realize that reduced reimbursements to hospitals will result in the identification of creative means to avoid fines. This has already begun.

Statistics from CMS indicate that unplanned re-admissions cost the Medicare program $17.4 billion in 2004 and that 50% of these readmissions were preventable. ¹ Reasons cited by a study from the Health Policy Research Program of the JDC Brookdale Institute for returning to the hospital were: the poor resolution of the main problem for the admission and inadequate post discharge care.²

What does this really mean? Communication between doctors and patients is poor in part because hospitalized patients are under physical and emotional stress. As a result explanations and directions easily are missed.

Doctors also do not speak in simple terms that patients understand. Patients fail to ask for a simple explanation or believe that the hospital staff is doing what they need to do.

Follow-Up Care is a Missing Link

A lack of follow-up care is a contributor to patients returning to the hospital. Most patients leave the hospital and fail to see their primary care physician within the recommended time frame or at all.

The primary care physician is the doctor who knows the patient best and in most cases have no idea they were hospitalized. Is there any wonder then that poor outcomes result when patients fail to follow instructions?

My older clients refuse home health care for physical and occupational therapy or skilled nursing because “there are just too many people coming to the house”. Others receive prescriptions to treat conditions related to the hospitalization and never have prescriptions filled or refuse to take the medications because “I already take enough pills”.

With all of this in mind, it is no wonder that patients are responsible for their refusals to follow medical recommendations which result in returning to the hospital. If more time was spent on healthcare education that discussed the reasons for following medical orders and the consequences of not doing so, would the frequency of patients returning to the hospital decrease?

The Role of Hospitals for Patient Education

Hospital discharge planners are responsible for coordinating the transitions of patients to return home or transfer to rehabilitation communities. They have a high number of patients to support and work on short time frames.

What if instead, there were dedicated hospital staff devoted solely to patient education about follow-up care, following medical orders, and the actions necessary to avoid returning to the hospital? And what if this meeting was held with the elderly person hospitalized and their family caregiver?

While states have enacted recent caregiver laws about informing family caregivers of the discharge of a family member, this law is a band-aid on a much larger problem. Individual healthcare literacy is a significant gap not only in the United States but worldwide.

Health insurance companies are reimbursed for caring for the sick. Informed and educated patients may need less care. So there seems to be a conflict about who is responsible for patients returning to the hospital.

In my opinion, it’s time consumers take charge of their health. So that health insurers, hospitals, and medical providers can do their job to care for patients while in their care but not be penalized for the actions of patients outside of the healthcare system.

References:

1. U.S. Agency for Healthcare Research and Quality

2. Health Policy Research Program, JDC Brookdale Institute, Jerusalem, Israel.

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