• How can readmissions be reduced?

    Interventions to reduce 30-day rehospitalization: a systematic review, by Hansen et al. (Annals of Internal Medicine, 2011), is a handy reference.

    The pitch:

    Among Medicare fee-for-service patients discharged from the hospital, 19.6% are rehospitalized within 30 days (1). The Medicare Payment Advisory Commission has estimated that three quarters of such rehospitalizations may be avoidable and annually account for $12 billion in excess health care costs (2). Others have estimated total hospital costs at $44 billion per year for rehospitalizations within 30 days of hospital discharge (3). The Patient Protection and Affordable Care Act designates reduction of avoidable rehospitalization as a target for health care cost savings and authorizes lower payments to hospitals with high risk-standardized rates of readmission.

    The swing:

    In this systematic review of studies evaluating interventions to reduce readmission within 30 days of hospital discharge, we did not identify a discrete intervention or bundle of interventions that appears to reliably reduce rehospitalization.


    I’m happy to not be running a hospital.


    • Here is an interesting study of a successful plan to reduce readmissions for congestive heart failure, the most common cause of readmission among both medical and surgical patients in the US.

      The study is imperfect in that it has no control — it attempts to use the past for control — but the results are spectacular and the innovating institution has adopted it as an ongoing policy with continuing good results. The savings in overrun of DRG payments and potential savings in penalties from readmissions have made the project a big winner for the health care system, a largish Midwestern integrated system now called Essentia.

      The link:http://www.innovations.ahrq.gov/content.aspx?id=275