Patient Responsibility to Stop Hospital Readmissions

 

By Pamela D. Wilson, MS, BS/BA, NCG, CSA

Hospital owners are screaming.  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 the patient to make sure actions do not result in a revolving door and a return to the hospital.

In my opinion fining a hospital for an issue for which they have only partial control will result in unintended consequences.  Why not fine the hospital and the patient equally?  The current administration 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:  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 stress and explanations and directions easily are missed. Doctors also do not speak in simple terms that patients understand.  Patients fail to ask for simple explanations.

Follow up care is another gray area.  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 has no idea they were hospitalized.  Is there any question 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 partially responsible for re-admission to hospitals.

Hospital discharge planners have the goal of sending patients home or to rehabilitation communities.  They have a high case load and the time they have available to spend per patient is limited.  Placing partial responsibility for self- education on the part of family caregivers and individuals leaving the hospital will help avoid re-admissions.  If the reasons for readmission were made clear to patients by discharge planners and patients were held financially responsible for the associated costs of returning to the hospital this might increase awareness that patients DO hold at least partial responsibility for their own care post hospitalization.

References:

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

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

© 2012, 2013 Pamela D. Wilson.  All Rights Reserved.

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