Unnecessary hospital readmissions have been a particularly hot topic since last April when the Centers for Medicare and Medicaid Services initiated the Care Transition Project, a pilot program to improve transitions across the healthcare continuum and thus reduce unnecessary hospital readmissions in 14 communities nationwide. Since then, Congress has been alerted to the $17.4 billion price tag associated with these readmissions and has proposed cutting Medicare payments when unnecessary readmissions occur. As a result of all this focus, providers in Jacksonville, Fla., are taking action, reports the Jacksonville Business Journal.
In January, the three-campus Mayo Clinic, including Mayo Clinic Florida, launched a system-wide initiative to slash avoidable hospital readmissions. The program initially will focus on three high-risk conditions: heart failure, heart attack and pneumonia. Avoidable hospital readmissions indicate "that something was missed at the time of discharge to prepare the patient for being home or a rehab facility," says Nancy Dawson, project chair for readmission rates and chair of the division of hospital medicine for Mayo Clinic Florida. The initiative will include creating a more focused transitional care program.
Brooks Home Care Advantage also has launched a program to reduce avoidable hospitalizations. Brooks' staff members see patients every day during the first two weeks they are home (the period when most readmissions occur). Patient education also is a key focus, with Brooks implementing a "call us first" program. Typically when patients call their doctors about a problem, the physicians send them to the emergency room, says Senior Vice President Karen Wright-Bennett. In this program, patients are encouraged to call Brooks so that staff can first visit and evaluate their needs. Brooks also has hired a transitional care manager to monitor its highest-risk patients for the first 30 days, as well as using telemedicine to monitor patients.
Discharge planning is especially critical in reducing avoidable readmissions among senior citizens who are discharged to home, according to the "Geriatric Consult" column at the American Medical News. Seniors often aren't prepared to handle their own care, and problems such as medication mistakes can quickly send them back to the hospital. Consequently, strong discharge planning and a comprehensive discharge list are essential.