Rehospitalization: The Penalties and How to Avoid Them

October 1, 2015

Rehospitalization, often synonymized with readmission, has a significant impact not only on your practice, but also on your patients and the entire U.S. health care system. 

The average cost of a hospital readmission is $11,200. The New England Journal of Medicine’s 2009 study on rehospitalization, an industry-changing report, found that of the 11,855,702 Medicare beneficiaries who had been discharged between 2003 and 2004, 19.6 percent were rehospitalized within 30 days—more than 2.3 million recurring patients in one year alone. As providers struggle to adapt to the Obama administration’s sweeping health care reform, the problem has only worsened. 

Let’s take a glance at how hospitals have evolved over the years and the challenges you face. Then, we’ll talk briefly about what you can do to minimize your rehospitalization rates. 

The Fragmentation of Hospital Outpatient Services

The outpatient system has changed drastically over the past few decades. The personal relationship between primary care physician and patient is far less prevalent than it was, say, 20 years ago. Back then, a family doctor would visit a patient in the hospital to check on them. Some would even make house calls. The transition from one type of care to the next was managed by the same physician. 

That’s rarely the case in today’s system, which is driven more by specialization and speed. Outpatient doctors don’t typically provide continuing care during or immediately after hospitalization anymore. Instead, the patient is transferred to a different caregiver, whose job is to treat and discharge them as swiftly as possible. In addition to the avoidance of overcrowding, hospitalists are incentivized to get patients out of the hospital within the Medicare reimbursement timeframe. The result is often an imbalance between care and cost.

Primary Contributors to Rehospitalization 

The New England Journal of Medicine found that half of patients discharged from the hospital never saw a doctor during their stay—obviously an alarming statistic given the inefficiencies they uncovered. As a result, the Centers for Medicare and Medicaid Services (CMS) sought to identify which health conditions contributed most to rehospitalization. They found those conditions to be:

  • Heart attack
  • Pneumonia
  • Congestive heart failure
  • COPD
  • Hip or knee replacement

The CMS kept close tabs on these subsets of patients to formulate a benchmark for limiting a hospital’s readmission rate based on patient demographics and the national average.

Rehospitalization Penalties

Hospitals are required to report all readmissions to the CMS, and, as you might know all too well, are not compensated for the care they provide for individuals who are readmitted. Furthermore, if a hospital exceeds their expected readmission rate for a given year, the CMS enforces additional penalties up to 3 percent of the hospital’s total Medicare reimbursement. We can say with certainty that a substantial percentage of hospitals suffer these penalties, many of them the maximum 3 percent. Overall, rehospitalization takes a toll on a facility’s finances, and hospitals are grappling with the challenge. 

A Vicious Cycle

Rehospitalization negatively affects everyone involved in health care. The system breeds pressure for providers and physicians to get patients out of the hospital, and it shows. If you were to poll a random selection of hospital patients and their families, most would tell you that they felt like they were being rushed out the door. Meanwhile, the risk of rehospitalization increases as patients are evaluated less thoroughly. Hospitals lose, patients lose, and the health care system as a whole suffers.

Home Care, Home Health, and Hospice as Outlets

The transition from hospital to further care is pivotal. It starts with educating the patient prior to discharge on how to manage their condition, but oftentimes, even patients who prefer to go home might not be able to fully care for themselves. That’s where having a reliable home health care team becomes the crutch to everything.

Home care, home health, and hospice are all viable options for post-hospitalization care. The problem is that each patient has their own unique situation that will determine which is best, and few in-home care providers offer all three services.

Mission does provide all three options, serving as a bridge of communication between hospitals and primary care providers. Together, home care, home health, and hospice effectively keep patients out of the hospital and in the comfort of their own homes, all while still providing the personalized care they need. The Mission difference is exemplified in:

  • Educating our staff to provide the highest level of care.
  • Services and training targeted specifically toward eliminating rehospitalization.
  • Hospice as a means of living rather than an aid for dying.
  • The resources of a corporate national care provider, with the personal approach of a small, local provider.
  • A 24-hour call center to field patients’ needs.

Don’t let your practice and patients suffer from the effects of rehospitalization. To learn more about how we can help, click here.

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