If it seems like I’ve been really interested in hospitals readmissions lately, it’s because I am. A hospital readmission is a complicated thing. What’s not complicated is we know that we don’t want hospital readmissions. They are expensive and costing healthcare a lot of money. What’s not as clear is who is responsible and how we can motivate them to reduce readmissions.
Most people believe that a primary care doctor is the key to reducing readmissions, but I broadened that discussion in my previous post about post-acute being the real cause of hospital readmissions. I’ll be really interested to work with people to discover what the real cause of hospital readmissions are in a hospital. Either way, I haven’t heard people making the argument that the hospital is the one that’s responsible for the hospital readmission. I guess there’s something to say about how quickly or slowly the hospital releases the patient from the hospital being a contributing factor, but I haven’t heard anyone argue that’s a significant contributor (I’d love to hear if someone has other info).
I think this is important to understand, because it could describe that the hospital who will get the financial benefit of reduced hospital readmissions isn’t the organization that can actually solve the problem. Does it make sense for us to be paying hospitals for reduced admissions when in fact it’s the primary care doctor or post-acute organizations that can really reduce the readmissions? Are we relying on hospitals to reach out to primary care docs and post-acute organizations in order to solve this problem?
Obviously, more and more hospitals are starting to get into ambulatory practices as well. In these cases, then the hospital can also be the primary care doctor. However, that’s still only a small portion of healthcare. What about the rest?
Of course, we shouldn’t cut the hospitals out of benefiting from reduced hospital readmissions. It’s hard for a primary care doctor to reduce the chance of a readmit if they don’t know that one of their patients was admitted. The hospital needs to be involved to let the primary care doctor know. Long term care and skilled nursing facilities likely can’t do it on their own either. For example, some don’t have the expertise to avoid the readmits. However, could they rely on the hospital experts on an as needed basis to get access to the skills they need?
The only way we’re going to really reduced hospital readmissions is by having all of these organizations (and the patient) get on the same page and rowing in the same direction. However, it seems the current reimbursement model only incentivizes the hospital to participate.