Rethinking Readmissions

Despite having one of the most technically advanced healthcare systems in the world, the United States continues to struggle with the most basic of tasks – efficient communication and care coordination amongst different providers.

Poor communication shows up most glaringly with readmissions which are, as the Wall Street Journal recently wrote, “a vexing problem” that costs Medicare an estimated $26 billion a year and affects nearly 1 in 5 beneficiaries. Transitioning a patient from the hospital to the home is a tenuous period and not enough focus is spent on this seemingly mundane period in the care for a patient.

A study by researchers at Yale and Columbia University of 3 million Medicare patients observed between 2007 and 2009 found that almost 25% of those with heart failure and 20% of heart attack patients and 18% of those with pneumonia were readmitted within 30 days, often for the same condition but also for a wide variety of other diagnoses. These numbers are staggering and, as the baby boomer population gets older, will undoubtedly explode unless we start to rethink how transitions of care are handled for patients moving from inpatient to out-patient.

As an orthopedic surgeon, I can state unequivocally that the post-hospitalization period is an extremely vulnerable time and requires rethinking. The current mindset is to simply get the patient out of the hospital and hopefully, their discharge follow-up magically works its way out as the patient transitions to outpatient care. This couldn’t be further from the truth. Patients do not get what they need, and the lack of communication and coordination falls squarely on the hospital and providers with whom care is provided.

In turn, ObamaCare will introduce various penalties and rewards for health systems in an effort to reduce readmissions through better discharge planning and coordination, followed by improved home-based follow-up and improved patient education.

Hospitals need to set up multi-disciplinary transitional care teams of providers to help shepherd patients from inpatient to outpatient. The heart and soul of this will involve leveraging existing technologies to create better communication amongst the various providers as well as the patient. Patients should be given a single contact, which is available 24/7 so that they could be guided through this transition and not simply rush back to the hospital, where the emergency room defaults to the most conservative option, which is readmission.

EMRs were an important first step in creating a single repository of data that can supply a fountain of information. But now it is incumbent on health systems to embrace communication technology to allow EMRs to become more actionable. We have the technology to create HIPAA compliant group messaging centered on a specific patient with multi-disciplinary providers able to see the same information and instantly apprise each other as new information becomes known. Instead, what we are currently deploying is a wonderful but expensive new information system that is fundamentally underutilized in everyday workflow.

Dr. Andrew A. Brooks has been in the private practice of orthopedic surgery since 1994, specializing in sports medicine, arthroscopy, and joint reconstruction. Dr. Brooks is board-certified by the American Board of Orthopedic Surgery and is a Fellow of the American Academy of Orthopedic Surgeons.