Policy-ish

One Solution For The Revolving Admissions Door At Hospitals

Partner content from Kaiser Health News

Revolving doors blur i i
iStockphoto.com
Revolving doors blur
iStockphoto.com

There's a new prescription for what's ailing the health care system, including one of the most intractable problems: hospital readmissions.

According to a recent study in the New England Journal of Medicine, 1 in 5 Medicare patients is back in the hospital within 30 days of being discharged. Three-quarters of those readmissions might have been avoided if providers had done a better job coordinating patients' post-discharge care, among other things, a report found. Avoidable readmissions cost $12 billion annually, according to the study.

Starting in October 2012, under the federal health law hospitals will be penalized if they have higher-than-expected rates of readmission for three conditions: heart attack, pneumonia and heart failure. What can be done?

Enter accountable care organizations. In case you're behind in your health policy reading, an ACO is a team of providers — hospitals, primary care doctors, home health agencies and the like — who agree to share responsibility for taking care of a group of patients. Because they're all jointly accountable for providing quality care, these providers have an incentive to coordinate care carefully and avoid duplicative tests and procedures. If they save money, they all share in the savings.

Integrated health systems like Kaiser Permanente, Geisinger and Mayo Clinic that have organized doctors, hospitals and ancillary services all under one umbrella already have many of the attributes of an accountable care organizations, experts say. (Kaiser Permanente is not affiliated in any way with Kaiser Health News.) Readmission rates at these health care systems show that providing coordinated care can make a difference.

At Kaiser Permanente, for example, readmission rates are 38 percent lower than those found in the New England Journal of Medicine study, says Dr. Robert Pearl, executive director and CEO of the Permanente Medical Group. Electronic medical records that help ensure coordinated patient care and keep everyone on the same treatment page are partly responsible for their success, he says.

The NEJM study found that half of patients didn't have a doctor's appointment within 30 days of leaving the hospital. At Kaiser Permanente, that wouldn't happen because post-discharge care would be arranged before the patient goes home, says Pearl. "There are no cracks between inpatient and outpatient care," he says.

Although integrated systems are indeed better positioned to coordinate care, they're not perfect, says Patricia Rutherford, vice president at the Institute for Healthcare Improvement, who has worked on reducing hospital readmission rates. "Even in an integrated system, we need to be more purposeful in our handovers," she says.

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