Solving the Hospital Readmissions Problem

One of the most interesting things I wrote about thanks to the HIMSS conference was what I called the real cause of hospital readmissions. I’m still interested in working with more hospitals to verify the data that’s presented in that blog post, but I’ll be surprised if it doesn’t play out as an important finding when it comes to reducing hospital readmissions.

In the post, I probably was a little aggressive in my statements about how the hospital can reduce readmissions through their own actions versus depending on home health, primary care doctors, or post-acute care providers. The good news is that my great readers always hold me accountable when I step too far over the line. In this case, Richard D. Tomlinson, RN, BSME, CMUP and Founder & CEO of Nuclei Health Consultancy, offered up a deeper perspective on the complexities associated with solving the hospital readmission problem.

I would like to take a moment to provide some perspective relative to your blog post today.

Hospital readmissions are, of course, clinically complex at times. In actuality, the risk for readmission can be influenced/increased due to lack of or missed opportunity for interventions prior to patient discharge. Effective quality measures, and robust analytics, with effective data feedback and clinical governance, can be deployed as components to an overall readmission reduction strategy; more on that later.

When we discuss readmissions we must consider the fact every case is unique; the circumstances, follow up care, coordination with 3rd party caregivers/providers (e.g. home health), level of transitional intervention, cultural influences, income levels, environment, stress levels. These factors are difficult to quantify, yet I do believe there is a way to translate these factors into reasonable algorithms.

I mentioned readmission as a strategy. Hospital readmission with most health systems I have worked with do not view it in strategic terms, and they must in my opinion in order to be effective (it could be argued Very often, initiatives are tactile in their core and therefore do not have a genesis of the strategic perspective when planning/implementing. As such, critical components such as clinical governance and workflow changes within the readmioften fall by the wayside or are missed completely. Add to that BI tools in the market today are not addressing predictive analysis for readmission risk as a dynamic in the overall care plan. A future-state, effective, model in my opinion would incorporate all the aforementioned factors, and in real-time track these factors and provide the care team with dynamic risk for readmission. That, combined with robust strategic tools and models in place, would have in my view significant outcomes.

Readmission engineering must be redesigned and retooled before any ROI level discussion can take place. Thank you for your fine Site and information exchange. All the Best, RDT.

I agree completely that the hospital readmission problem is not a simple problem. However, I still think a lot of people are looking in the wrong place. I look forward to digging into this problem a lot more. Reducing hospital readmissions is great for everyone involved.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

1 Comment

  • Hospital readmission reduction is a very simple problem. Its cause is usually is loose and haphazard discharge planning and failure to commit to excellence in providing care. While lots of folks over complicate the problem, the root problems are in process breakdowns and the lack of a commitment to excellence in care for doing the job once and right the first time.
    Re-admissions reductions are a true team effort involving the discharging physician and the pharmacy as well and the discharge planners at the hospital. Most re-admissions occur because of a lack of patient education and ineffective disease management teaching for the patients who never really “get it” about their problems and what they can do to stay out of the hospital.
    The transition of care and connection with their Primary Care Physicians and Needed specialist are also a critical part of the puzzle almost always neglected by the hospitals in their programs who arrogantly think the problem can be solved “hopsitalcentircally”
    True care coordination to allow changes ion behavior to become deeply rooted with patients then becomes the last key to stopping the problem.
    Sadly most readmission programs are aimed at preventing readmission for 30 days rather than aiming at a true raising of the quality of care of the patients at risk for the long run.
    And before anyone asks at an enlightened hospital that cooperates with care coordination and allows real time emr access and closes the discharge planning loops, we have been able to achieve readmits rates in the 10-12% range for the sickest patients in rural areas with all the usual associated problems……again not all that hard

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