Mary Knight is in the lobby of Elyria Medical Center in, Elyria Ohio. She was admitted three days earlier because of difficulty breathing, and she was waiting for her husband to pick her up. Knight explained she has asthma and a lung disease called COPD. In her hands is a packet from the hospital containing 30 days of free steroids and antibiotics.
“And then they also gave me a prescription for Cingular which is going to help with the asthma,” Knight said.
Every patient with a diagnosis of COPD at University Hospitals Elyria Medical Center leaves with that packet. It’s one of the ways they are trying to keep this fragile group of patients from landing back in the hospital and driving up their readmission rates.
The government thinks sick patients are coming back to the hospital too soon. So a couple of years ago, the department of Health and Human Services decided to give hospitals a financial nudge in the right direction – by penalizing the hospitals’ Medicare reimbursements if the number of patients who came back to the hospital within 30 days exceeded the national average.
It’s supposed to encourage hospitals to find ways to keep patients healthier. The result is that hospitals are spending lots of money to find ways to keep patients from coming back – but there’s no consensus about what’s best for patients.
Wei Jen Chang, a hospitalist at UCSD who has studied the problem of readmission rates in patients with COPD, has done research that suggests it’s not the quality of care in the hospital that’s critical to keeping COPD patients healthy. It’s what happens and doesn’t happen after they leave.
“Not having good follow up, not being compliant with their medications, not having appropriate oxygen therapies…” Chang said, citing common problems that occur after discharge.
Chang and his team have lobbied his hospital for money to hire coordinators to follow up with their COPD patients and help them get outpatient services, but so far they’ve been unsuccessful.
“As it turns out, even if you are making a difference in the lives of patients for the better, you may not be making a difference for the better in your hospital’s bottom line,” Chang says.
At Metro Health Medical Center in Cleveland, officials have done something similar to what Chang hopes to do. They hired a half dozen staff to identify patients at risk for readmission and guide their outpatient care. As a result, they have managed to reduce their readmission rates by 20 percent, said Alfred Connors, Metro Health’s chief of medicine.
“We can make quite a difference in the readmission rate,” says Connors “It’s clearly better for our patients – so we should do that.
But the question is what are hospitals willing to invest to do it? It’s clear that hospitals want healthier patients. It’s less clear how much of their own financial health they’ll need to sacrifice to get there.
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