Hospital Readmissions: Challenges in Pulmonary Medicine Practice - Part 1

David H. Au, MD, MS, kicked off the Hospital Readmissions session at the American Thoracic Society 2013 conference with his presentation on “Defining the Role of the Practitioner, Scientist and Policymaker.” In the presentation, Dr Au says that it is important for all stakeholders in the healthcare industry to focus on hospital readmission rates. About 20% of admitted hospital patients are readmitted within 30 days, which the Medicare Payment Advisory Committee suggests costs an average of $12 billion. These costs and readmissions must be considered, especially since the advisory committee found that 13.3% of readmissions are usually preventable.

Although hospital readmissions are easy to measure, they are difficult to improve. Dr Au said it is important for policy makers, scientists, and practitioners to re-conceptualize the issue of readmission, and therefore how it is measured. Reduction in such rates comes from a focus on good health and quality of life. This is a societal issue, not just an isolated problem of the hospitals. If healthcare professionals wish to reduce readmissions, they must support constructs for overall health in the outpatient and home environment. They should also consider the importance of greater community engagement.

Dr Jerry Krishnan, with his presentation on “Transitions of Care: Identifying the Key Stakeholders in the Readmissions Process,” says that such significant engagement comes through identifying key stakeholders. Some programs like Boost, a national initiative led by the Society of Hospital Medicine, and Project Red, based out of Boston University Medical Center, have been successful in assisting patients as they transition from hospital to home, reducing their readmission risks. The reason these programs work is because the caregivers provide a social support circle for the patient.

Dr Krishnan finds there are various proactive procedures that stakeholders can implement at patient admission, near patient discharge, and at patient discharge to reduce likelihood of readmission. However, the most critical decisions involve overall support, and ensuring patient understanding. The key takeaway is that all stakeholders from nurses and physicians, to case managers and family, are involved in the discharge process and patient engagement. This will guarantee a smoother transition for the patient from the hospital to outpatient care.

Dr J Daryl Thorton also noted the complexities of improving hospital readmission rates. His presentation on “COPD, Asthma, and Pneumonia: Revisiting Predictors of Readmission in Respiratory Patients,” showed there must be a consideration for factors that go beyond the care received at the index hospitalization, including the fact that some re-hospitalization is not disease specific. Dr Thorton says to improve readmission rates, “A better understanding of the factors occurring outside of the hospital (ie, income inequality) are needed to make a meaningful impact.” Some programs, like the Hospital Readmissions Reduction Program (HRRP), which began in October 2012, fine hospitals for excessive readmission rates. These fines are intended to incentivize providers to be more cautious upon initial admission, and with follow-up procedures.

In examining hospital readmissions, 2 things are apparent: they are frequent, and they are costly. It will be critical to garner the support of all healthcare stakeholders in the admission and discharge processes to ensure improved patient transition from the hospital to outpatient environments. Communication goes beyond simply telling; it must be a dialogue between patient and provider with all independent risk factors considered.