With Medicare reimbursement penalties starting last month, hospitals have been implementing transitional care improvements to improve outcomes and lower readmission rates. But care coordination proves more complicated when it comes to homeless patients.
Challenges arise in the hospital discharge process when determining what "discharge to home" really means for these vulnerable patients, emergency physician Kelly Doran, a Robert Wood Johnson Foundation Clinical Scholar, wrote this week in a Huffington Post blog post.
While Doran claimed discharging homeless patients to the streets should be considered a "never event," the ER doc also acknowledged the flaws of sending them to traditional shelters. Shelters may offer homeless patients a place to sleep, they don't guarantee recovery care.
However, laws prohibiting hospitals from discharging patients to homeless shelters can hurt hospitals' bottom lines. For example, thanks to state law, New York hospitals have been housing hundreds of patients with nowhere to go for months or even years. A lingering patient can cost a hospital more than $100,000 a year, FierceHealthcare previously reported.
"Patients who leave the hospital and are homeless cycle through a revolving door of costly, inefficient and dangerous care from the hospital to the streets or shelter and then back again," Doran wrote.
To end the cycle, hospitals can improve care transitions from their facilities to shelters with better communication and safe transportation arrangements, according to a study published in the June Journal of General Internal Medicine.
In the quantitative analysis of recent hospital experiences, 27 percent of homeless patients were discharged after dark, and 11 percent stayed on the streets on the first night after discharge.
A lack of coordination with shelters can lead to big problems for hospitals, with patient dumping violations costing thousands of dollars in fines and legal fees.
Another way to coordinate care for homeless patients is using post-discharge recuperative centers to help them recover from hospitalizations and take their medications. The more than 50 such centers in operation already have helped curb readmissions by giving homeless patients who are too sick to be on the streets or in a shelter a proper place to heal, Doran noted.