Medicare penalties for hospital readmissions – but don’t forget the patient’s responsibilities

The following is a guest post by Harold DeMonaco, who is one of our expert story reviewers on HealthNewsReview.org.

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Last week, Kaiser Health News reported on the upcoming reimbursement penalties that most hospitals in the United States are about to incur. Their analysis (pdf file) of Medicare data suggest that 2,211 hospitals will face penalties in October for having too many readmissions of patients admitted for heart attack, heart failure or pneumonia, within 30 days of discharge.  The penalties range from 0% up to 1% maximum.  The maximum amount of reimbursement withheld can increase annually up to a maximum of 3%.

Hospital readmissions for these three diagnoses are likely to be the result of a number of factors.  While some of the factors, such as guideline based treatments and coordination of inpatient care are within the scope of a hospital’s responsibilities, others important factors may not be.  Individual physician practice patterns, outpatient services and facilities and insurance coverage for out of hospital services all play an important role.  No list would be complete however with patient factors.  Patient health literacy, income, social and family supports are all likely to be significant factors.

The media is predictably focusing on the hospitals in their area but I have yet to see anything written about the patient and family responsibilities.

There are things that patients and their families can do to reduce the likelihood of a hospital readmission.  The After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries (pdf file) has a number of suggestions.  While they are intended for folks enrolled in Medicare, they are applicable for patients of all ages:

“Here are some steps you can take to help the weeks and months after you or a loved one leaves the hospital go as smoothly as possible:

• Ask your hospital if it has special planners who can help you prepare to leave the hospital.

• Create a detailed, written plan, often called a discharge plan, that includes important information, such as the following:

-The date you are leaving the hospital

-Where you are going after you leave the hospital

-How you will get there from the hospital

-A schedule of follow-up appointments with primary care providers or specialists

         -A list of your medical problems

-A list of allergies

-A list of medications, including when to take them and for how long, and any possible side effects

-How you will fill your prescriptions

-A list of any equipment you might need, such as a cane or wheelchair

-What you will do if you have a medical problem in the middle of the night

• Bring your plan, including a list of all your medications, to every appointment with a primary care provider or specialist.
• Go over your plan with a family member or friend.
• Be familiar with the quality of care at hospitals in your area”

As the healthcare industry attempts to balance quality and cost, the patient will likely become a major factor.  The media can play an important role in improving the health literacy of patients and families.