1 in 5 Medicare patients readmitted within month - page 2

"...............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... Read More

  1. by   Altra
    There have been some great points raised here about the various inadequacies of typical discharge practices.

    However, I'm not sure that the readmission is always a "problem" that can be "solved." Medicare folks, by definition, are those aged 65 and over and/or those with serious chronic conditions. This patient population simply requires inpatient care at a greater frequency than the population as a whole.

    One example: a close family friend, age 82, is a chronic CHFer. He is compliant with meds and appointments. He simply has, as he calls it, a bad heart. There is no solution to this at this stage of his life. He does all that he can to manage s/s, but 3 or 4 times a year, he becomes acutely dyspneic, requires emergency treatment, and is typically admitted for 3-4 days. Yes, this is very costly ... and this is just one case of one CHF patient.
  2. by   Kabin
    Quote from jjjoy
    Increasing cost effectiveness, though, isn't the same as profit-generating. Once the initial savings has gone into effect, then that becomes the new base line. In the time that follows, the cost-effectiveness of case managers becomes invisible. The budget is adjusted to reflect the increased efficiency and CMs would have to squeeze harder and harder to be able to show continued cost savings. Eventually, case managers look only like a cost center not a revenue-generator, and so that budget is more likely to be cut, workloads increased such that CMs can't be as effective, etc. So, in the long run, I don't see that it's as easy as "case management pays for itself by ensuring cost effective treatments."

    That's why I think case management needs to be primarily for the sake of ensuring appropriate patient care, and not primarily as a cost-saving function for health care organizations.

    In addition, case management ideally should be separate from specific health facilities. How long would a hospital CM follow a discharged patient? 1 week? 1 month? 1 year? What if they were admitted to a different hospital after that?
    Every time a decision is made to limit cost money is saved. The idea is to limit costs through cost effective resource utilization. There's two sides of the ledger; increasing income and reducing costs. If a company reduces its costs it can grow its business thereby increase income. By the way, with regard to medicare monies spent I couldn't care less about a company making profits.
  3. by   ®Nurse
    Quote from Kabin
    Case management pays for itself by ensuring cost effective treatments. The problem is most of us paying into private insurance balk at additional health care option restrictions. But as far as medicare goes, case management should be alive and well.

    Until the US looks at healthcare as a limited resource, hospitals, doctors, pharmaceutical companies, insurance companies, lawyers, etc will continue to squeeze every last dollar out of our healthcare system.

    This makes me curious about how well the Kaiser hospital system works to prevent frequent flyers.

    Any Kaiser Nurses out there who would know?

    (For those who are not familiar with Kaiser - it is a huge conglomerate of many "Kaiser owned and Kaiser run" hospitals that are all under the Kaiser corporate umbrella.)
  4. by   WalkieTalkie
    Um, is it just me, or does MEDICARE'S system itself actually force patients out of the hospital before they are ready!?
  5. by   ®Nurse
    Probably very true.

    Medicare is HUGE and I don't think there's anyone out there who can totally explain each and every Medicare law.
  6. by   lamazeteacher
    Quote from Kabin
    Case management pays for itself by ensuring cost effective treatments. The problem is most of us paying into private insurance balk at additional health care option restrictions. But as far as medicare goes, case management should be alive and well.

    Until the US looks at healthcare as a limited resource, hospitals, doctors, pharmaceutical companies, insurance companies, lawyers, etc will continue to squeeze every last dollar out of our healthcare system.
    That's why "Universal healthcare" (single party payer) is the best way to go, provided it is run by medical professionals who have enough clout/authority to negotiate with physicians and pharmaceutical companies for the best prices. New hirees for the program should be intelligent and compassionate, as well as able to discern a ruse when they hear one.

    Research by pharmaceutical companies is always a "conflict of interest", and should be banned. Insurance companies are the greatest consumer of healthcare dollars, and should be banished!
  7. by   nursemarion
    Please! Why are they not requesting home health??? So many patients go home with no teaching. That is what we do! Some only need a few visits to assess their condition and instruct in meds and disease process. One ER visit alone can cost as much as an entire episode (60 days) of home health services. We can help keep people out of the hospital. If you are sending a patient home with lots of new meds, unstable conditions, or other problems- recommend home health.
  8. by   nerdtonurse?
    Don't forget the other side of the fence, tho....we've got folks who know they can come into the hospital for two weeks out of every month, complain of unspecified abdominal/belly pain, get their drug of choice, get yet ANOTHER set of CTs/MRIs, be told AGAIN that there's nothing wrong, so then their "abdominal pain" becomes "chest pain" and they get another 3 days for a complete cardiology assessment, and then the "chest pain" becomes "intractable migraines" and then we do head CTs, carotid dopplers, etc, and that gets them another couple of days, and then the abdominal pain's back. These are not elderly sick folks, these are people in their 30's and 40's who've figured out to work the system. And they are on the callbell every time their PRN pain med's available..."Can I have phenerghan, demerol, and a diet Pepsi?"

    We're a smallish hospital, and what burns me up is when we've got people who have positive cardiac enzymes, crappy EKGs, but they're having to sit in the ER because the ICU's full and we've got 5 beds full of the "Demerol and diet Pepsi" folks....
  9. by   carla71
    These patients that are getting discharged to early...do they qualify for home health? Home health could do teaching as well and follow up. I work in a long term facility and I have seen many come back way to soon.
  10. by   nursemarion
    To qualify for home health you have to:

    1. Have a skilled need- require the services of a nurse or therapist, not custodial care, not just an aide for a bath, but a skilled need. A skilled need means assessment, teaching, or other interventions that require a skilled professional.

    2. You must be homebound if you are under Medicare. Homebound does not mean immobile or bedbound. It means you leave the house infrequently or leave the house only with assistance or considerable taxing effort. Someone who goes to Bingo every Tuesday is not homebound. Someone whose daughter takes her out once a month to see her doctor is. Many Medicare patients become short of breath and must rest after walking a short distance. They go out, but it is difficult for them. That is homebound. My mother is 70 and needs a walker and handicapped spaces. She can walk very short distances and though she can get out, she is essentially homebound.

    Some insurance does not require homebound status, only medical necessity. Most agencies will send a nurse to evaluate the patient if you are not sure. The same goes for hospice care, an evaluation visit is possible if you are unsure.

    We can make visits for a short time, or longer if needed, often only a few visits until the patient has a handle on things. Just don't forget we are out there. Case management is a big part of what we do!
    Last edit by nursemarion on Apr 5, '09
  11. by   oramar
    Quote from mama_d
    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.
    It is laughable. The goverment caused this problem by encouraging early discharges, then complains that people are being readmitted. The main cause of readmission from what I could see was that the person was discharged to early in the first place. Round and round and round we go, where it stops nobody knows.
  12. by   croloff303
    This is a result of mis-managed case management and pressure on MD's to discharge discharge discharge!!!