COMMENTARY

No Return Trips: Hospitals Under Pressure to Lower Readmissions

Shmuel Shoham, MD

Disclosures

April 23, 2015

In This Article

Unplanned Hospital Readmissions

Unplanned 30-day readmissions are admissions to an acute care hospital within 30 days of discharge from the index hospitalization. It does not matter whether the admission is to the same hospital or to another facility, as long as it is an acute care hospital. (Planned readmissions, such as return to the hospital for a scheduled revascularization procedure, are viewed as a continuation of the index hospitalization and are not counted.)

Risk adjustment based on mathematical models is applied to try to account for differences among hospitals in the types of patients (eg, age, comorbid conditions, and discharge diagnoses) they care for.

A mandate to reduce rehospitalizations is built into the Affordable Care Act, and penalties are being applied to hospitals with higher-than-acceptable rates. Individual hospitals' unplanned readmission rates after hospitalization for a variety of conditions (including pneumonia) are publicly available at Data.Medicare.gov.

Reducing readmission rates is no longer a choice, a "noble goal," or "nice to do." With increased scrutiny and the possibility of suffering painful penalties, the healthcare industry has started to invest substantial resources to deal with this issue—an important development.

For clinicians, trying to provide excellent care while under pressure to discharge patients from the hospital to an outpatient setting that is often ill prepared to receive them has been a major challenge. Clinicians know that rehospitalization soon after discharge can be frustrating to patients and their families, and that taking one step forward only to take two steps back and end up in the hospital again is scary and dispiriting. In many instances, a cobbled-together network of outpatient providers, home healthcare agencies, pharmacists, and clinical laboratories—as well as an often overwhelmed patient and family—constitutes the front line for preventing readmission.

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