Reducing Readmissions Under Obamacare: Doctor’s Orders?
Last month I wrote about the rise of hospital readmission penalties in fiscal 2015 and questioned the Hospital Readmissions Reductions Program’s effectiveness in increasing quality of care, in part due to factors independent of the hospital that lead to readmission.
Hospitals attempt to combat readmissions by implementing transitional care interventions. The American Journal of Managed Care conducted a controlled trial to evaluate the impact of such programs. Patients were randomly assigned to either standard care or a 90-day hospital-based transitional care program featuring patient education ahead of discharge, post-discharge follow-up, an available hotline and additional interview sessions and symptom checks. No statistical difference in readmission rates between the standard care and intervention group was found. Their findings are consistent with other trials, which have shown that even robust and comprehensive interventions are ineffective in slowing readmissions.
The study’s lead author, Ariel Linden, DrPH, speculates that the hospitals’ relationships with primary-care doctors makes the difference. Linden found that community hospitals lacked the ability to compel primary care physicians (PCPs) to collaborate on avoiding acute events post-discharge on an outpatient basis, which requires close patient monitoring and same-day appointments upon mal symptoms. Community hospitals without collaborative relationships with local family doctors are disadvantaged in the Hospital Readmissions Reductions Program compared to large integrated systems that can refer patients directly to their own PCPs for follow-up.
This blog has written about hospital acquisition of physician practices and their negative consequences on pricing of services in the marketplace. This research indicates that hospital-owned groups may be better at reducing readmissions.
Could this issue be an ethical matter then? Referring to the doctors.
Talked with an owner of an ambulance company today. They implemented a new peogram to work around re admission penalties. That are now taking the doctors to the patients. No Bs…actually a new service to work around the penalties. No matter what the goverment comes up with business will adapt and find a way to make money….
http://www.kamagrapillrx.com
Referring to the doctors.Could this issue be an ethical matter then?
Do you think it could be an overly conservative fear of the Stark anti self referral laws that prevent hospitals and doctors from referring to entities in which they have a financial interest or is it just the opposite, hospits only work with their own integrated PCP systems?
Thank you. I think you are on to something. There is a bias today against physician ownership of facilities, but not hospitals rolling up physician practices. If we opened up the system to allow any corporate structure that providers wanted to try, I think we’d see an explosion in innovation in service delivery.
Please note that there is not now known to be a difference in readmission rates between hospitals with and without collaborative arrangements with PCPs. Per the article, it is an area that deserves further research. Why? because the answer is not yet known.
Thank you Doctor Mike. You are absolutely correct, Ariel Linden’s speculation is self-admittedly anecdotal and far from empirical. Do you have any comments about the dynamic of physician compliance regarding readmissions?
“Compliance” would seem to be the wrong word. I believe access is the issue with physicians unable/unwilling to leave a hole in their schedule for the “what if a recently discharged patient has an issue.” Also, all too often the patient is given too little guidance at discharge and the PCP is given little to zero information at the time of discharge. It is only a partial solution but I believe that trusting the patient with more detailed instructions (tailored specifically to them, not some boiler plate printout) and giving the PCP a summary of the stay faxed/emailed/senttoEHR within moments of discharge would be very helpful, and as some hospitals do exactly that it would be easy to study if this increased communication made a difference.
Thank you. Increased access, information, and communication involving all parties portrays a more complete equation than physician compliance. This blog will continue to monitor the penalization, intervention, and reduction efforts regarding hospital readmissions.