1 in 5 Medicare patients readmitted within month

  1. 10
    "...............NEW YORK – One in five Medicare patients end up back in the hospital within a month of discharge, a large study found, and that practice costs billions of dollars a year. The findings suggest patients aren't told enough about how to take care of themselves and stay healthy before they go home, the researchers said. A few simple things — like making a doctor's appointment for departing patients — can help, they said.
    The study found that a surprising half of the non-surgery patients who returned within a month hadn't even seen a doctor between hospital stays.
    "Hospitals put more effort into the admission process than they do into the discharge process," said Dr. Eric Coleman, one of the study's authors from the University of Colorado in Denver."


    ............... http://news.yahoo.com/s/ap/20090401/...UEHH.G1wDVJRIF






    This article just peeves me. I can remember doing lengthy patient teaching on discharge day before a patient went home.



    NOW, the patients are sicker, and get kicked out of the ol' front double door when they should be in the hospital for another two days to a week!



    The patients are being sent home in such a high acuity state, that there is NO WAY you can cover all the little things that can go wrong once they get home. It used to be that they would have those little problems at the bedside, and the nurse could intervene and do teaching along the way.


    It's really sad.
    gonzo1, vashtee, Keysnurse2008, and 7 others like this.
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  3. 24 Comments so far...

  4. 6
    when i was a nsg student in the mid 90's, i was saying this very exact thing.
    that pts are discharged before they're ready, which only increases readmits drastically.
    they're just figuring this out now?

    signing off with my homer simpson "DUH"!

    leslie
    SuesquatchRN, jjjoy, lindarn, and 3 others like this.
  5. 6
    This article just peeves me. I can remember doing lengthy patient teaching on discharge day before a patient went home.



    NOW, the patients are sicker, and get kicked out of the ol' front double door when they should be in the hospital for another two days to a week!



    The patients are being sent home in such a high acuity state, that there is NO WAY you can cover all the little things that can go wrong once they get home. It used to be that they would have those little problems at the bedside, and the nurse could intervene and do teaching along the way.


    It's really sad.
    I fully agree, how long after calling some doctors do you have to wait for an appointment? Most of these older patients would be compliant to doctor visits, but a lot need to arrange transportation much less the time it takes to even get the appointment. Some are still too acute on discharge. The health system is set up for acute stay for younger patients...those able to "bounce back quickly" and not for older ones that it takes time to improve. An extra day or two of inhospital stay would have made a world of difference to some I imagine. What is very sad about this is instead of looking at days in the hospital, it sounds like the brunt of the blame is AGAIN going to be placed on nursing.
    ®Nurse, lindarn, herring_RN, and 3 others like this.
  6. 5
    Quote from Straydandelion
    I fully agree, how long after calling some doctors do you have to wait for an appointment? Most of these older patients would be compliant to doctor visits, but a lot need to arrange transportation much less the time it takes to even get the appointment. Some are still too acute on discharge. The health system is set up for acute stay for younger patients...those able to "bounce back quickly" and not for older ones that it takes time to improve. An extra day or two of inhospital stay would have made a world of difference to some I imagine. What is very sad about this is instead of looking at days in the hospital, it sounds like the brunt of the blame is AGAIN going to be placed on nursing.
    There's no reason why a doctor, upon making the discharge hospital visit, can't note when he/she wants to see a patient next. They can give that to whoever makes appointments in their office, and have them call the patient to set up the post whatever office visit, the day after they're home. That person should be instructed to ask if the patient has questions for the doctor or nurse, and notify the doctor or nurse if the answer is "Yes".

    I've always thought, while doing the required teaching at discharge, that patients don't listen well and their perception is quite limited while thinking about all the things they need to do at home, other than take care of themselves. The check lists are useless, and the time within which all the teaching needs to be done is quite unrealistic, especially on OB.
    ®Nurse, Straydandelion, lindarn, and 2 others like this.
  7. 1
    Well, maybe it's because I'm a new grad, but "TEACHING"????? There's barely enough time to get the discharge paperwork done, with the demands of patientcare still breathing down one's neck. I hope that the time management thing gets better. Plus, if we only had to care for 5 med-surg patients, the teaching aspect would be a little more do-able. It's no wonder lots of new-grads don't want med-surg for more than a year....it's a killer. And most of all, I don't "feel good" about the rushing and time-pressure.
    lamazeteacher likes this.
  8. 1
    All this concern about readmission is about reimbursement (income ) to the hospital, As long as the hospital was getting reimbursed well for readmission they had no incentive to assure quality follow up care as it would decrease their income. Also follow up care is the responsibility of the private MD who may not even be associated with the hospital. Now CMS wants to decrease or end reimbursements for readmission. Couple this with more MDs opting out of Medicare it is only going to decrease quality of care and out of pocket cost will increase for the elderly.
    It is all about the business model and wanting to keep high incomes as opposed to quality of care.
    lindarn likes this.
  9. 4
    Floor nurses have had this one figured out cold for longer than I've been doing it...as leslie said, "D'oh!"

    Medicare/medicaid is all about "get 'em out, get 'em out, get 'em out" and no one there has seemed to figure out yet that all that translates into is "put 'em back, put 'em back, put 'em back!"

    Back when I worked days, I cannot begin to tell you the number of times that I argued with CM about whether or not a patient was ready for discharge. Especially with a newly diagnosed renal, CHF, or diabetic patient; there is no way we can squeeze in adequate teaching in a three day stay!

    I've been saying for years that we need to have nurse educators for specific disorders on staff at the hospital, whose only job is to go from patient to patient and ensure that adequate education is dispensed to patients, and then to FOLLOW UP on it. Like a phone call at home three days after d/c..."And how have your weights been?" or "How have your fingersticks been?" and the all important "Are you able to afford your medication?"

    We have a diabetic educator on staff, who has to cover the whole hospital (census 370-400). You know what she does? Puts stickers on the education sheets for the nurses to check of specific teaching and hands the patients a 60 page booklet. Dietician does the same thing...hands the patients a 30 page booklet. They honestly expect that just giving a 90 page long stack of papers to a sick eighty year old covers them as far as "education" goes, and the floor staff is left to pick up the slack. Makes me want to

    I am sick to death of the short term bottom line thinking that goes on...if facilities would be willing to make a little bit more of an investment in our patients and their health at the outset, then we'd be seeing less readmits and better patient satisfaction.
    Ayvah, ®Nurse, leslie :-D, and 1 other like this.
  10. 3
    My experience is that once a doctor tells a patient they are discharged they have little to no interest in listening to the nurse when she/he comes in to give discharge instructions.

    It's more like, "yeah, yeah, the doctor told me I could leave an hour ago...get me out of here."
    sk8ergirl, teeniebert, and verp like this.
  11. 1
    Most of medicare dollars are spent in the last 2 years of an individual's life and tends to be for multiple chronic illnesses. Very sad.

    There was a local news story last night of a clinic and the NP reported seeing up to 30 pts per day. Pts usually hadn't seen a dr for some time and most had numerous issues unrelated to the visit like skin cancer, high blood pressure. She frequently ran over her alloted 15 min visit. It was her clinic and at times she didn't have enough money to pay for herself at the end of the month. She also complained about poor reimbursements and was considering closing the clinic.

    Where will all the practitioners come from if and when we have healthcare for all?
    SuesquatchRN likes this.
  12. 1
    Quote from ocankhe
    All this concern about readmission is about reimbursement (income ) to the hospital, As long as the hospital was getting reimbursed well for readmission they had no incentive to assure quality follow up care as it would decrease their income.
    Also follow up care is the responsibility of the private MD who may not even be associated with the hospital.
    I think the problem lies more with the latter than the former. Since when is the hospital responsible for ensuring that patients are following up with their physician after discharge and that they aren't experiencing problems? And if this IS the hospital's responsibility, who is paying for that extra work done by the hospital? Can anyone seriously think that close follow-up of discharged patients is just the "cost of doing business" as a hospital when reimbursement rates are already being cut as close to the bone as possible?

    I do think it's a great idea to have a case management model for patients with on-going issues but, again, who pays for it? Private insurance companies have this for some patients... but the incentive is more about cost-savings than about providing quality care.

    Is there any way to make individual case management profitable? Those who need it most are the least likely to be able to afford any extra out of pocket expenses. And even those who could afford an extra expense would probably balk at paying extra for an individual case manager in addition to their other health care expenses.

    The other option is to make case management for those qualify (based on their health condition) a public service paid for through tax dollars. But more tax-funded programs would not be welcome by many.

    Sigh! Aren't there any easy answers?
    Altra likes this.


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